Provider Demographics
NPI:1255437661
Name:ROBINSON, JILL ANN (MA CCCSLP)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ANNE
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCCSLP
Mailing Address - Street 1:4450 N SACRAMENTO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3828
Mailing Address - Country:US
Mailing Address - Phone:773-220-0580
Mailing Address - Fax:866-807-7334
Practice Address - Street 1:4450 N SACRAMENTO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3828
Practice Address - Country:US
Practice Address - Phone:773-220-0580
Practice Address - Fax:866-807-7334
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007252235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635546OtherBLUE CROSS BLUE SHIELD