Provider Demographics
NPI:1811476989
Name:PINO, JILLIAN L (RBT)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:L
Last Name:PINO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 S YOST AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-3188
Mailing Address - Country:US
Mailing Address - Phone:812-822-0605
Mailing Address - Fax:812-822-2496
Practice Address - Street 1:2010 S YOST AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-3188
Practice Address - Country:US
Practice Address - Phone:812-822-0605
Practice Address - Fax:812-822-2496
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician