Provider Demographics
NPI:1861884645
Name:HILL, JAY (MSA)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:HILL
Suffix:
Gender:M
Credentials:MSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 HUNT AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-4909
Mailing Address - Country:US
Mailing Address - Phone:307-789-0981
Mailing Address - Fax:
Practice Address - Street 1:121 HUNT AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-4909
Practice Address - Country:US
Practice Address - Phone:307-789-0981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services