Provider Demographics
NPI:1447593900
Name:DUTHIE, JILL KATHLEEN (PHD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:KATHLEEN
Last Name:DUTHIE
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3244 BROOKSIDE RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2381
Mailing Address - Country:US
Mailing Address - Phone:209-951-6491
Mailing Address - Fax:209-951-6497
Practice Address - Street 1:3244 BROOKSIDE RD
Practice Address - Street 2:SUITE 180
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2381
Practice Address - Country:US
Practice Address - Phone:209-951-6491
Practice Address - Fax:209-951-6497
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CASP15869235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist