Provider Demographics
NPI:1437645421
Name:WONG, JILL HUANG (PHD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:HUANG
Last Name:WONG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:HUANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3585 MAPLE ST STE 150
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-9115
Mailing Address - Country:US
Mailing Address - Phone:805-253-2291
Mailing Address - Fax:
Practice Address - Street 1:3585 MAPLE ST STE 150
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-9115
Practice Address - Country:US
Practice Address - Phone:805-253-2291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29449103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist