Provider Demographics
NPI:1679242416
Name:PERKINSON, JILL HOLTZMAN
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:HOLTZMAN
Last Name:PERKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 COOPERS GROVE RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27537-7671
Mailing Address - Country:US
Mailing Address - Phone:252-213-4763
Mailing Address - Fax:
Practice Address - Street 1:104 MARKET ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27537-3751
Practice Address - Country:US
Practice Address - Phone:252-431-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8452235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist