Healthcare Provider Details

I. General information

NPI: 1649871401
Provider Name (Legal Business Name): SUSANNE JEAN HILLIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 E MAIN ST
LANCASTER OH
43130-3903
US

IV. Provider business mailing address

1177 POST RD E
WESTPORT CT
06880-5436
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-0042
  • Fax:
Mailing address:
  • Phone: 614-499-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC1100641
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: