Provider Demographics
NPI:1841960994
Name:WILSON, JILL CELESTE (MA, CCC/SLP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:CELESTE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:C
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC/SLP
Mailing Address - Street 1:15077 PLANTATION RDG
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-7147
Mailing Address - Country:US
Mailing Address - Phone:214-632-0104
Mailing Address - Fax:
Practice Address - Street 1:1000 S HOUSTON ST
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-2214
Practice Address - Country:US
Practice Address - Phone:972-032-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15554235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist