Provider Demographics
NPI:1336312057
Name:LODDE GREIVES, JILL STEPHANIE (AUD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:STEPHANIE
Last Name:LODDE GREIVES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 N GLADSTONE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5392
Mailing Address - Country:US
Mailing Address - Phone:812-376-3071
Mailing Address - Fax:
Practice Address - Street 1:1655 N GLADSTONE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5392
Practice Address - Country:US
Practice Address - Phone:812-376-3071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002427A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist