Provider Demographics
NPI:1013576065
Name:CONOLLEY, HILLARY MENDOZA
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:MENDOZA
Last Name:CONOLLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:MENDOZA
Other - Last Name:GAMBOA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7033 E TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1262
Mailing Address - Country:US
Mailing Address - Phone:907-729-6580
Mailing Address - Fax:
Practice Address - Street 1:4130 SAN ERNESTO AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2875
Practice Address - Country:US
Practice Address - Phone:907-729-5070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician