Provider Demographics
NPI:1023049921
Name:EVERETT, JILL BLOODWORTH (CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:BLOODWORTH
Last Name:EVERETT
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:BLOODWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC SLP
Mailing Address - Street 1:320 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5117
Mailing Address - Country:US
Mailing Address - Phone:229-227-0800
Mailing Address - Fax:229-227-0833
Practice Address - Street 1:320 N BROAD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5117
Practice Address - Country:US
Practice Address - Phone:229-227-0800
Practice Address - Fax:229-227-0833
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP 006334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist