Provider Demographics
NPI:1619296365
Name:GOODHEART, JILL C (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:GOODHEART
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 1:4911 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-1749
Mailing Address - Country:US
Mailing Address - Phone:913-287-8851
Mailing Address - Fax:913-287-5431
Practice Address - Street 1:4911 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1749
Practice Address - Country:US
Practice Address - Phone:913-287-8851
Practice Address - Fax:913-287-5431
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist