Healthcare Provider Details

I. General information

NPI: 1376575415
Provider Name (Legal Business Name): KELLI D HILL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E STATE ST STE 435
MASON CITY IA
50401-3325
US

IV. Provider business mailing address

103 E STATE ST
MASON CITY IA
50401-3300
US

V. Phone/Fax

Practice location:
  • Phone: 641-458-3072
  • Fax: 641-458-3072
Mailing address:
  • Phone: 641-458-3072
  • Fax: 641-458-3072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number00906
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: