Healthcare Provider Details

I. General information

NPI: 1558084905
Provider Name (Legal Business Name): JILL KINNAMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 13TH ST
GERING NE
69341-4144
US

IV. Provider business mailing address

1519 10TH ST
GERING NE
69341-2818
US

V. Phone/Fax

Practice location:
  • Phone: 308-436-2350
  • Fax:
Mailing address:
  • Phone: 308-436-3125
  • Fax: 308-436-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: