Provider Demographics
NPI:1538284906
Name:OWENS, JILL PATRICIA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:PATRICIA
Last Name:OWENS
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-0512
Mailing Address - Country:US
Mailing Address - Phone:317-773-2893
Mailing Address - Fax:317-773-2893
Practice Address - Street 1:8525 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-5236
Practice Address - Country:US
Practice Address - Phone:317-773-2893
Practice Address - Fax:317-773-2893
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002455A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist