Healthcare Provider Details

I. General information

NPI: 1770778136
Provider Name (Legal Business Name): AMBER RUTH HILL M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 8TH AVE
KENOSHA WI
53140-3700
US

IV. Provider business mailing address

4955 SUSSEX LN
GREENDALE WI
53129-2024
US

V. Phone/Fax

Practice location:
  • Phone: 262-564-0067
  • Fax:
Mailing address:
  • Phone: 414-828-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: