Individual ProviderJill C SouthworthSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersPractice Address5606 S 147th St, Omaha, NE 68137-2648(402) 715-8200PECOS EnrollmentBased on the most recent information from CMS, provider Jill C Southworth does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1487026407Provider TypeIndividualFull NameSouthworth, Jill CTitleMrs.CredentialCCC-SLPGenderFemaleSole ProprietorNoEnumeration Date10/29/2015Last Updated10/29/2015Contact InformationPractice LocationPractice Address5606 S 147th St, Omaha, NE 68137-2648Phone(402) 715-8200FaxUnlisted FaxMailing LocationMailing Address5606 S 147th St, Omaha, NE 68137-2648Phone(402) 715-8200FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode235Z00000XPrimaryDescriptionSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID8427362909DescriptionOtherIssuerNDE STAFF IDNebraska