Provider Demographics
NPI:1740301431
Name:ZEPEDA, JILLIAN DEE (DT)
Entity type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:DEE
Last Name:ZEPEDA
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-4304
Mailing Address - Country:US
Mailing Address - Phone:815-434-0857
Mailing Address - Fax:815-434-2260
Practice Address - Street 1:1013 ADAMS ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-4304
Practice Address - Country:US
Practice Address - Phone:815-434-0857
Practice Address - Fax:815-434-2260
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILJZ81790805P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist