Provider Demographics
NPI:1679380430
Name:SCHOFIELD, JILL HATHEWAY
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:HATHEWAY
Last Name:SCHOFIELD
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 1:812 S CHIPMAN ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-4154
Mailing Address - Country:US
Mailing Address - Phone:989-721-6735
Mailing Address - Fax:
Practice Address - Street 1:1975 W M 21
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-8163
Practice Address - Country:US
Practice Address - Phone:989-721-6735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician