Provider Demographics
NPI:1386970077
Name:WODNICK, JILL KIMBERLY (MA, CD)
Entity type:Individual
Prefix:PROF
First Name:JILL
Middle Name:KIMBERLY
Last Name:WODNICK
Suffix:
Gender:F
Credentials:MA, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2417
Mailing Address - Country:US
Mailing Address - Phone:973-655-1628
Mailing Address - Fax:
Practice Address - Street 1:133 HIGH ST.
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4442
Practice Address - Country:US
Practice Address - Phone:973-655-1628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula