Provider Demographics
NPI:1063651255
Name:BOCCARDO, JILLIAN MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:MARIE
Last Name:BOCCARDO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4675 VIA LOS SANTOS
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-1346
Mailing Address - Country:US
Mailing Address - Phone:805-964-2700
Mailing Address - Fax:805-964-2722
Practice Address - Street 1:4675 VIA LOS SANTOS
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-1346
Practice Address - Country:US
Practice Address - Phone:805-964-2700
Practice Address - Fax:805-964-2722
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP18272235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist