Provider Demographics
NPI:1699810168
Name:COX, JILL BERGSTROM (MS-CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:BERGSTROM
Last Name:COX
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 1:434 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62694-1162
Mailing Address - Country:US
Mailing Address - Phone:217-742-9569
Mailing Address - Fax:
Practice Address - Street 1:434 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62694-1162
Practice Address - Country:US
Practice Address - Phone:217-742-9569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist