Provider Demographics
NPI:1003538083
Name:WALTHER, JILL HARRELL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:HARRELL
Last Name:WALTHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20550 FAIRFIELD GREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6122
Mailing Address - Country:US
Mailing Address - Phone:281-213-1768
Mailing Address - Fax:
Practice Address - Street 1:20550 FAIRFIELD GREEN BLVD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6122
Practice Address - Country:US
Practice Address - Phone:281-213-1768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16277235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist