Provider Demographics
NPI:1336436476
Name:AULT, JILL (PSYD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:AULT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 LONETREE BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-3772
Mailing Address - Country:US
Mailing Address - Phone:916-663-7121
Mailing Address - Fax:916-672-6774
Practice Address - Street 1:5701 LONETREE BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-3772
Practice Address - Country:US
Practice Address - Phone:916-663-7121
Practice Address - Fax:916-672-6774
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19413103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical