Individual
JILL WIDEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
775 ELLSBOROUGH CT, JOHNS CREEK, GA 30005-2575
(404) 518-0944
Mailing address
775 ELLSBOROUGH CT, JOHNS CREEK, GA 30005-2575
(404) 518-0944
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP007721
GA
Other
Enumeration date
07/27/2016
Last updated
07/27/2016
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