Provider Demographics
NPI:1083931174
Name:DANIEL, JILL N (HIS)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:N
Last Name:DANIEL
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#1 CENTRAL MALL
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503
Mailing Address - Country:US
Mailing Address - Phone:903-223-0022
Mailing Address - Fax:870-286-1427
Practice Address - Street 1:1 CENTRAL MALL
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2420
Practice Address - Country:US
Practice Address - Phone:903-223-0022
Practice Address - Fax:870-286-1427
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30853237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist