Healthcare Provider Details

I. General information

NPI: 1982917415
Provider Name (Legal Business Name): JEFFREY HILL PSYD, LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6425 NICOLLET AVE
RICHFIELD MN
55423-1675
US

IV. Provider business mailing address

6425 NICOLLET AVE
RICHFIELD MN
55423-1675
US

V. Phone/Fax

Practice location:
  • Phone: 612-861-1675
  • Fax: 612-861-3446
Mailing address:
  • Phone: 612-861-1675
  • Fax: 612-861-3446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP 5464
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberLP 5464
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP5464
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberLP 5464
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberLP 5464
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberLP 5464
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: