Provider Demographics
NPI:1912107418
Name:BERRY, JILL MARIE
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:PAWELTZKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:331 ROUNDUP CIRCLE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539
Mailing Address - Country:US
Mailing Address - Phone:956-287-3766
Mailing Address - Fax:
Practice Address - Street 1:1701 DOVE AVE STE D
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3955
Practice Address - Country:US
Practice Address - Phone:956-664-9395
Practice Address - Fax:956-661-9495
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100370235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist