Provider Demographics
NPI:1992902720
Name:GILL, JAMIE LYNN (MA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:GILL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9180 SCHILLTON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9375
Mailing Address - Country:US
Mailing Address - Phone:708-655-2985
Mailing Address - Fax:
Practice Address - Street 1:215 CHURCH ST APT 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4518
Practice Address - Country:US
Practice Address - Phone:180-097-4638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46001722A235Z00000X
IL146009670235Z00000X
FLSA9785235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist