Individual
MRS. JILL C SOUTHWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
5606 S 147TH ST, OMAHA, NE 68137-2648
(402) 715-8200
Mailing address
5606 S 147TH ST, OMAHA, NE 68137-2648
(402) 715-8200
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8427362909
NDE STAFF ID
NE
Enumeration date
10/29/2015
Last updated
10/29/2015
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