Provider Demographics
NPI:1043839194
Name:VOLKER, JILLIAN RAE (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:RAE
Last Name:VOLKER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:IA
Mailing Address - Zip Code:50674-1339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-1748
Practice Address - Country:US
Practice Address - Phone:563-568-3477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096808235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist