Provider Demographics
NPI:1487042453
Name:OLDHAM, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:OLDHAM
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:PO BOX 14597
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76094-1597
Mailing Address - Country:US
Mailing Address - Phone:817-277-8870
Mailing Address - Fax:817-277-8875
Practice Address - Street 1:2307 HUNTERS GLN
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76306-1148
Practice Address - Country:US
Practice Address - Phone:972-467-2602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst