Individual
JILL LYNN GROOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1417 OGLES CREEK CT, LEBANON, IL 62254-1834
(618) 581-3194
Mailing address
1417 OGLES CREEK CT, LEBANON, IL 62254-1834
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146004292
IL
Other
Enumeration date
11/08/2017
Last updated
11/08/2017
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