=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518886811
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILL FREDRICKS BROWN ED. S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2026
-----------------------------------------------------
Last Update Date | 07/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 545 BECKETT RD STE 207
-----------------------------------------------------
City | LOGAN TOWNSHIP
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08085-1512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-214-2509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 BRIARCLIFF RD
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-2905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-470-8094
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------