Provider Demographics
NPI:1548320815
Name:ATKINSON, JILL R (PHD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8931 HURON ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260-6806
Mailing Address - Country:US
Mailing Address - Phone:303-853-3606
Mailing Address - Fax:303-428-7618
Practice Address - Street 1:11285 HIGHLINE DR
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-3076
Practice Address - Country:US
Practice Address - Phone:303-853-3606
Practice Address - Fax:303-428-7618
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0499103TC0700X, 103T00000X
CO3397103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101936Medicare PIN