Provider Demographics
NPI:1679766539
Name:LOMONACO, JILL RENAE (MS SLP)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:RENAE
Last Name:LOMONACO
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:RENAE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16109 W MOHAVE ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-7951
Mailing Address - Country:US
Mailing Address - Phone:574-903-1099
Mailing Address - Fax:
Practice Address - Street 1:16109 W MOHAVE ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-7951
Practice Address - Country:US
Practice Address - Phone:574-903-1099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP5562235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist