MEDICARE: DR. JILL W BLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	3122	OH

General Provider Information

NPI Number	:	1518770205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL W BLEY

Provider Business Mailing Address
First Line	:	750 RED BUD AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-1531
Country	:	US
Telephone Number	:	513-602-3358
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 RED BUD AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-1531
Country	:	US
Telephone Number	:	513-602-3358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2025
Last Update Date	:	01/28/2025

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