Provider Demographics
NPI:1821144874
Name:GILL, PATRICIA JOAN (MS)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JOAN
Last Name:GILL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:J
Other - Last Name:VANIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-280-8100
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:425 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2100
Practice Address - Country:US
Practice Address - Phone:402-452-5000
Practice Address - Fax:402-452-5028
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100252727-00Medicaid
NE100251783-00Medicaid
NE100251772-00Medicaid
NE39813OtherBCBS BT
NE100251782-00Medicaid
NE39809OtherBCBS ENT