Provider Demographics
NPI:1801812235
Name:STOBBER, JILL ELIZABETH (LAT, AT,C)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:ELIZABETH
Last Name:STOBBER
Suffix:
Gender:F
Credentials:LAT, AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1368
Mailing Address - Country:US
Mailing Address - Phone:262-763-6816
Mailing Address - Fax:
Practice Address - Street 1:100 FIELD DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-4116
Practice Address - Country:US
Practice Address - Phone:262-534-3189
Practice Address - Fax:262-534-4971
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI320-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer