Provider Demographics
NPI:1922199819
Name:MCCARTY, JILL MARIE (MS SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 VALLETTA RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2305
Mailing Address - Country:US
Mailing Address - Phone:502-458-0082
Mailing Address - Fax:
Practice Address - Street 1:2503 VALLETTA RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2305
Practice Address - Country:US
Practice Address - Phone:502-458-0082
Practice Address - Fax:502-454-0660
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist