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General NPI Number Information
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NPI Number | 1821455361
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Entity Type | Organization
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Legal Business Name | JILL HARDEE
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Dates
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Enumeration Date | 01/27/2016
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Last Update Date | 01/27/2016
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Provider Practice Location Address
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Address Line | 43335 K BEACH RD BLDG E SUITE 8
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City | SOLDOTNA
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State | AK
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Zip | 99669-8280
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Country | US
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Telephone | 907-598-3470
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7501
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City | NIKISKI
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State | AK
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Zip | 99635-7501
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Country | US
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Telephone | 907-598-3470
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Fax |
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Authorized Official
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Title or Position | BEHAVIORAL HEALTH CLINICIAN
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Name | JILL A HARDEE
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Credential | LMSW
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Telephone | 907-598-3470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1035
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License Number State | AK
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