Individual
MS. JILL MAXINE FELDBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA-CCC,SP/L
Contact information
Practice address
8100 ROOSEVELT BLVD STE 101, PHILADELPHIA, PA 19152-2900
(215) 535-1314
(854) 424-2049
Mailing address
8100 ROOSEVELT BLVD STE 101, PHILADELPHIA, PA 19152-2900
(215) 535-1314
(215) 331-4208
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL001548L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SL001548L
LICENSE NUMBER
PA
Enumeration date
03/10/2006
Last updated
04/13/2021
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