Basic Information
| Provider Information | |||||||||
| NPI: | 1508050006 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLESSNER | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.H.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 GREENHILL RD | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193803910 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 SKILES BLVD | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193827321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005787906 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2007 | ||||||||
| LastUpdateDate: | 07/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2004024756 | MO | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SL009718 | PA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 06114 | MD | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 41YS00615600 | NJ | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 01-0001122 | DE | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.