Provider Demographics
NPI:1407173321
Name:EBERHARDT, JILL DENISE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:DENISE
Last Name:EBERHARDT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:DENISE
Other - Last Name:VAN DEN HEMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1903 23RD ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NE
Mailing Address - Zip Code:68305-2404
Mailing Address - Country:US
Mailing Address - Phone:402-770-7367
Mailing Address - Fax:
Practice Address - Street 1:300 CEDAR ST
Practice Address - Street 2:
Practice Address - City:TARKIO
Practice Address - State:MO
Practice Address - Zip Code:64491-1174
Practice Address - Country:US
Practice Address - Phone:660-736-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-02
Last Update Date:2010-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1266235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist