Provider Demographics
NPI:1720277874
Name:HENDRIX, JILL THOMAS (AUD)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:THOMAS
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:THOMAS
Other - Last Name:SHEETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:190 KIMEL PARK DR STE 131
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6946
Practice Address - Country:US
Practice Address - Phone:336-718-5763
Practice Address - Fax:336-718-9861
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5745231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist