MEDICARE: JILL KATHERINE SUFFREDINI MA, LPC, MS, RD

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	101YP2500X	Professional Counselor	16015	TX

General Provider Information

NPI Number	:	1114801453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL KATHERINE SUFFREDINI MA, LPC, MS, RD

Provider Business Mailing Address
First Line	:	6204 WALLING LN
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-6161
Country	:	US
Telephone Number	:	972-473-4917
Fax Number	:	972-473-4917

Provider Business Practice Location Address
First Line	:	5220 SPRING VALLEY RD STE 545
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-2482
Country	:	US
Telephone Number	:	214-405-3031
Fax Number	:

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

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	07/31/2025

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