Provider Demographics
NPI:1124246640
Name:HILL, MARY K (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:K
Last Name:HILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E CAMPUS VIEW BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5691
Mailing Address - Country:US
Mailing Address - Phone:614-847-9008
Mailing Address - Fax:
Practice Address - Street 1:1 E CAMPUS VIEW BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5691
Practice Address - Country:US
Practice Address - Phone:614-847-9008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5490103TC1900X, 103TH0100X, 103TR0400X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP24112Medicare ID - Type UnspecifiedMEDICARE