Provider Demographics
NPI:1548336837
Name:PEREZ, JILL SUSAN (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SUSAN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:SUSAN
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:36397 N GANTZEL RD
Mailing Address - Street 2:102
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7335
Mailing Address - Country:US
Mailing Address - Phone:480-567-2987
Mailing Address - Fax:480-347-0240
Practice Address - Street 1:36397 N GANTZEL RD
Practice Address - Street 2:102
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7335
Practice Address - Country:US
Practice Address - Phone:480-567-2987
Practice Address - Fax:480-347-0240
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4178235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist