Provider Demographics
NPI:1083919302
Name:O'NEIL, JILLIAN (MA CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:MA CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4035
Mailing Address - Country:US
Mailing Address - Phone:516-769-1439
Mailing Address - Fax:
Practice Address - Street 1:217 OAK ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-4035
Practice Address - Country:US
Practice Address - Phone:516-769-1439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020681235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist