Provider Demographics
NPI:1326549338
Name:CLOSEME, JILL MARIE (MS , CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:CLOSEME
Suffix:
Gender:F
Credentials:MS , CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 BLOOMFIELD ST STE 203
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3271
Mailing Address - Country:US
Mailing Address - Phone:814-266-3196
Mailing Address - Fax:
Practice Address - Street 1:336 BLOOMFIELD ST STE 203
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3271
Practice Address - Country:US
Practice Address - Phone:814-266-3196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012778235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist