Provider Demographics
NPI:1043486749
Name:SANCHEZ, JILLIAN MARIE (MA-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:MARIE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:MA-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 ASHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-6008
Mailing Address - Country:US
Mailing Address - Phone:219-384-5455
Mailing Address - Fax:
Practice Address - Street 1:2509 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-6008
Practice Address - Country:US
Practice Address - Phone:219-384-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46001782A235Z00000X
IN22004975A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist