Provider Demographics
NPI:1659793198
Name:HILD, KELLY JEAN (MED, BCBA)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JEAN
Last Name:HILD
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JEAN
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:KASILOF
Mailing Address - State:AK
Mailing Address - Zip Code:99610-0602
Mailing Address - Country:US
Mailing Address - Phone:860-652-5520
Mailing Address - Fax:860-652-5520
Practice Address - Street 1:PO BOX 602
Practice Address - Street 2:
Practice Address - City:KASILOF
Practice Address - State:AK
Practice Address - Zip Code:99610-0602
Practice Address - Country:US
Practice Address - Phone:860-652-5520
Practice Address - Fax:860-652-5520
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK130138103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst