Provider Demographics
NPI:1942878160
Name:STOCKBURGER, JILL WHITTINGTON
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:WHITTINGTON
Last Name:STOCKBURGER
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:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-0102
Mailing Address - Country:US
Mailing Address - Phone:901-614-1902
Mailing Address - Fax:
Practice Address - Street 1:815 N MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38107-4608
Practice Address - Country:US
Practice Address - Phone:901-614-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty