Provider Demographics
NPI:1134394273
Name:PROSSER, JILL NICOLE (MA)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:NICOLE
Last Name:PROSSER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:NICOLE
Other - Last Name:VANBLARICUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:800 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2553
Mailing Address - Country:US
Mailing Address - Phone:618-395-7340
Mailing Address - Fax:618-395-6289
Practice Address - Street 1:800 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2553
Practice Address - Country:US
Practice Address - Phone:618-395-7340
Practice Address - Fax:618-395-6289
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242000601235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist