Provider Demographics
NPI:1598938714
Name:WIDIKER, JILL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:WIDIKER
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 1:410 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:STRUM
Mailing Address - State:WI
Mailing Address - Zip Code:54770-7868
Mailing Address - Country:US
Mailing Address - Phone:715-695-3349
Mailing Address - Fax:
Practice Address - Street 1:18601 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773-8605
Practice Address - Country:US
Practice Address - Phone:715-538-4361
Practice Address - Fax:715-538-1700
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2622-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist