Provider Demographics
NPI:1548386535
Name:EDWARDS, JILL NOEL (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:NOEL
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:NOEL
Other - Last Name:MOFFETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:485 MEREDITH DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:IL
Mailing Address - Zip Code:62684-8180
Mailing Address - Country:US
Mailing Address - Phone:217-416-2203
Mailing Address - Fax:217-416-2203
Practice Address - Street 1:485 MEREDITH DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:IL
Practice Address - Zip Code:62684-8180
Practice Address - Country:US
Practice Address - Phone:217-416-2203
Practice Address - Fax:217-416-2203
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.005622235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist