MEDICARE: JILL M MATHENIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1184128704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL M MATHENIA

Provider Business Mailing Address
First Line	:	1496 ILLINOIS ROUTE 121
Second Line	:
City	:	TOLEDO
State	:	IL
Zip	:	62468-4214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1496 ILLINOIS ROUTE 121
Second Line	:
City	:	TOLEDO
State	:	IL
Zip	:	62468-4214
Country	:	US
Telephone Number	:	217-923-3135
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	03/20/2018

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Directions to “ JILL M MATHENIA ” Practice Location

Language	Start Address	Practice Location

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