Basic Information
| Provider Information | |||||||||
| NPI: | 1184239618 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILL | ||||||||
| FirstName: | PATTI | ||||||||
| MiddleName: | JO | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 784 E 540 N | ||||||||
| Address2: | |||||||||
| City: | TOOELE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840741993 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 406 1ST AVE S | ||||||||
| Address2: | |||||||||
| City: | LEWISTOWN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 594573020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065356545 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2020 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 9846137-3501 | UT | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 44277 | MT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.