Provider Demographics
NPI:1336395961
Name:GRESHAM, JILL COLE (AUDIOLOGIST)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:COLE
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9430 PARK WEST BLVD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4200
Mailing Address - Country:US
Mailing Address - Phone:865-693-6065
Mailing Address - Fax:865-531-6325
Practice Address - Street 1:9430 PARK WEST BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4200
Practice Address - Country:US
Practice Address - Phone:865-693-6065
Practice Address - Fax:865-531-6325
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1416231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ027061Medicaid