Provider Demographics
NPI:1659856474
Name:DEMAN, JILL SUSAN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SUSAN
Last Name:DEMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18501 ROTUNDA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3891
Mailing Address - Country:US
Mailing Address - Phone:313-996-1993
Mailing Address - Fax:313-996-1935
Practice Address - Street 1:18501 ROTUNDA DR STE 100
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3891
Practice Address - Country:US
Practice Address - Phone:313-996-1993
Practice Address - Fax:313-996-1935
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000785235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist