Provider Demographics
NPI:1538269451
Name:GERTZ, JIL M (MA/CCC-SLP)
Entity type:Individual
Prefix:
First Name:JIL
Middle Name:M
Last Name:GERTZ
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5552 S FORT APACHE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-7694
Mailing Address - Country:US
Mailing Address - Phone:702-641-8255
Mailing Address - Fax:702-399-8255
Practice Address - Street 1:5552 S FORT APACHE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7694
Practice Address - Country:US
Practice Address - Phone:702-641-8255
Practice Address - Fax:702-399-8255
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP117235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3402049Medicaid