MEDICARE: JILL MARIE COONEY

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	103K00000X	Behavior Analyst	BEH-001845	AZ

General Provider Information

NPI Number	:	1902472145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL MARIE COONEY

Provider Business Mailing Address
First Line	:	2748 N EDDY DR
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-0702
Country	:	US
Telephone Number	:	928-600-2190
Fax Number	:

Provider Business Practice Location Address
First Line	:	2748 N EDDY DR
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-0702
Country	:	US
Telephone Number	:	928-600-2190
Fax Number	:

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

Provider Enumeration Date	:	05/28/2021
Last Update Date	:	03/22/2026

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Directions to “ JILL MARIE COONEY ” Practice Location

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