Provider Demographics
NPI:1285891861
Name:VANHAAREN, JILL MARGARET (MED)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:MARGARET
Last Name:VANHAAREN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 MORSE LANDING DR
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IN
Mailing Address - Zip Code:46034-9577
Mailing Address - Country:US
Mailing Address - Phone:317-984-1779
Mailing Address - Fax:
Practice Address - Street 1:800 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-1983
Practice Address - Country:US
Practice Address - Phone:765-236-1239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003193A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist