Provider Demographics
NPI:1962955112
Name:HILL, ROBERT D (PHD, ABPP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:HILL
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 S 500 E
Mailing Address - Street 2:STE 101
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1039
Mailing Address - Country:US
Mailing Address - Phone:385-227-8941
Mailing Address - Fax:385-227-8941
Practice Address - Street 1:34 S 500 E
Practice Address - Street 2:STE 101
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1039
Practice Address - Country:US
Practice Address - Phone:385-227-8941
Practice Address - Fax:385-227-8941
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-24
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT115278-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1598725426Medicaid