MEDICARE: JILL N. HENDRICKS SLP

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	41YS00594000	NJ

General Provider Information

NPI Number	:	1124451042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL N. HENDRICKS SLP

Provider Business Mailing Address
First Line	:	734 NEWMAN SPRINGS RD
Second Line	:
City	:	LINCROFT
State	:	NJ
Zip	:	07738-1523
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	734 NEWMAN SPRINGS RD
Second Line	:
City	:	LINCROFT
State	:	NJ
Zip	:	07738-1523
Country	:	US
Telephone Number	:	732-212-1910
Fax Number	:

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

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	08/14/2013

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