Provider Demographics
NPI:1407050321
Name:ANDERSON, JILL ELLEN (RRT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ELLEN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8779 INDIAN VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-1792
Mailing Address - Country:US
Mailing Address - Phone:970-201-5931
Mailing Address - Fax:
Practice Address - Street 1:8779 INDIAN VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549-1792
Practice Address - Country:US
Practice Address - Phone:970-201-5931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2825227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered