Provider Demographics
NPI:1174791586
Name:WARREN, JILL DAVIS (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:DAVIS
Last Name:WARREN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5503
Mailing Address - Street 2:
Mailing Address - City:EMERALD ISLE
Mailing Address - State:NC
Mailing Address - Zip Code:28594-5503
Mailing Address - Country:US
Mailing Address - Phone:252-422-6801
Mailing Address - Fax:
Practice Address - Street 1:7903 FOREST DR
Practice Address - Street 2:
Practice Address - City:EMERALD ISLE
Practice Address - State:NC
Practice Address - Zip Code:28594-2834
Practice Address - Country:US
Practice Address - Phone:252-422-6801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1748235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist