Provider Demographics
NPI:1568609626
Name:MCCARTHY, JILL JACKSON (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:JACKSON
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 SYDNEY TER
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7566
Mailing Address - Country:US
Mailing Address - Phone:615-758-5080
Mailing Address - Fax:
Practice Address - Street 1:14625 LEBANON RD STE G
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-4620
Practice Address - Country:US
Practice Address - Phone:615-758-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2502235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist