Provider Demographics
NPI:1427257302
Name:RIDER, JILL ZIMMERMANN (MCD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ZIMMERMANN
Last Name:RIDER
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:ZIMMERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD
Mailing Address - Street 1:10740 N GESSNER DR
Mailing Address - Street 2:STE 310
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:281-890-8908
Practice Address - Street 1:21216 NORTHWEST FWY
Practice Address - Street 2:STE 310
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4695
Practice Address - Country:US
Practice Address - Phone:281-890-6155
Practice Address - Fax:281-894-2765
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51626231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K5794Medicare PIN