Individual
MRS. JILL A WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
2602 DIAMOND SPUR ST, KINGMAN, AZ 86401-7290
(928) 692-9246
(928) 753-3637
Mailing address
2602 DIAMOND SPUR ST, KINGMAN, AZ 86401-7290
(928) 692-9246
(928) 753-3637
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0470
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0470
HEALTH DEPT. LIC.
AZ
Enumeration date
04/18/2007
Last updated
07/08/2007
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