Provider Demographics
NPI:1831348168
Name:FAHNHOLZ, JILL R (MSED CFY-SLP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:FAHNHOLZ
Suffix:
Gender:F
Credentials:MSED CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4239 FARNAM ST
Mailing Address - Street 2:SUITE # 509
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2868
Mailing Address - Country:US
Mailing Address - Phone:402-551-7338
Mailing Address - Fax:
Practice Address - Street 1:4239 FARNAM ST
Practice Address - Street 2:SUITE # 509
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2868
Practice Address - Country:US
Practice Address - Phone:402-551-7338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE178235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist