Provider Demographics
NPI:1598961575
Name:WINTER, JILL RENEE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:RENEE
Last Name:WINTER
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 1:820 2ND RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:KS
Mailing Address - Zip Code:66937-8911
Mailing Address - Country:US
Mailing Address - Phone:785-455-3738
Mailing Address - Fax:
Practice Address - Street 1:820 2ND ROAD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:KS
Practice Address - Zip Code:66937-8911
Practice Address - Country:US
Practice Address - Phone:785-455-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1668235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1668OtherKDHE LICENSE #