Provider Demographics
NPI:1174214043
Name:HILTON, JEFFREY W
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:HILTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32624 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SEDGEWICKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63781-4394
Mailing Address - Country:US
Mailing Address - Phone:304-650-4250
Mailing Address - Fax:
Practice Address - Street 1:32624 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SEDGEWICKVILLE
Practice Address - State:MO
Practice Address - Zip Code:63781-4394
Practice Address - Country:US
Practice Address - Phone:304-650-4250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician