Provider Demographics
NPI:1801994991
Name:WYANT, JILL (AUD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:WYANT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 N DURANGO DR STE 314
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4598
Mailing Address - Country:US
Mailing Address - Phone:702-834-5886
Mailing Address - Fax:702-834-5752
Practice Address - Street 1:6850 N DURANGO DR STE 314
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4598
Practice Address - Country:US
Practice Address - Phone:702-834-5886
Practice Address - Fax:702-834-5752
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV119-A237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1801994991Medicaid