Provider Demographics
NPI:1285142729
Name:DIFEBBO, JILL MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:DIFEBBO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CRICKET AVE APT B
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2217
Mailing Address - Country:US
Mailing Address - Phone:609-576-9016
Mailing Address - Fax:
Practice Address - Street 1:3537 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3701
Practice Address - Country:US
Practice Address - Phone:610-723-7771
Practice Address - Fax:610-723-7772
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11995235Z00000X
PASL015154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist