Provider Demographics
NPI:1265266258
Name:HILLEGEIST, JERI
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:
Last Name:HILLEGEIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 W 50 N STE W8
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2010
Mailing Address - Country:US
Mailing Address - Phone:435-790-6954
Mailing Address - Fax:
Practice Address - Street 1:365 W 50 N STE W8
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2010
Practice Address - Country:US
Practice Address - Phone:435-790-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician