Basic Information
| Provider Information | |||||||||
| NPI: | 1528339538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILL | ||||||||
| FirstName: | TERRI | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A., CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 E BACK BAY RD | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434029228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198231080 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 620 E WATER ST | ||||||||
| Address2: | |||||||||
| City: | DESHLER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435161327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192786921 | ||||||||
| FaxNumber: | 4192782910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2012 | ||||||||
| LastUpdateDate: | 01/23/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP-1991 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.