Provider Demographics
NPI:1942443239
Name:KIMBLE, JILL SYTH (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SYTH
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:E
Other - Last Name:SYTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1080 NEW HOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-5906
Mailing Address - Country:US
Mailing Address - Phone:406-579-7226
Mailing Address - Fax:
Practice Address - Street 1:1080 NEW HOLLAND DR
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5906
Practice Address - Country:US
Practice Address - Phone:406-579-7226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1216235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist