Provider Demographics
NPI:1972809226
Name:FLINGOS, JILL THERESA (SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:THERESA
Last Name:FLINGOS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 HERON AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-3119
Mailing Address - Country:US
Mailing Address - Phone:305-512-5757
Mailing Address - Fax:305-512-5757
Practice Address - Street 1:1160 HERON AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-3119
Practice Address - Country:US
Practice Address - Phone:305-512-5757
Practice Address - Fax:305-512-5757
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890179100Medicaid