Provider Demographics
NPI:1962425173
Name:WALTERS, JILL ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:ANNE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:ANNE
Other - Last Name:WALTERS-PACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1502 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-5602
Mailing Address - Country:US
Mailing Address - Phone:325-672-9999
Mailing Address - Fax:325-672-5237
Practice Address - Street 1:1502 N 1ST ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5602
Practice Address - Country:US
Practice Address - Phone:325-672-9999
Practice Address - Fax:325-672-5237
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31455103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist