Provider Demographics
NPI:1134457567
Name:LEVOS CARLSON, JILLIAN CHRISTINA (BS, SLPA)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:CHRISTINA
Last Name:LEVOS CARLSON
Suffix:
Gender:F
Credentials:BS, SLPA
Other - Prefix:MISS
Other - First Name:JILLIAN
Other - Middle Name:CHRISTINA
Other - Last Name:LEVOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, SLPA
Mailing Address - Street 1:25102 JEFFERSON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-1707
Mailing Address - Country:US
Mailing Address - Phone:951-461-1190
Mailing Address - Fax:951-461-7975
Practice Address - Street 1:25102 JEFFERSON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-1707
Practice Address - Country:US
Practice Address - Phone:951-461-1190
Practice Address - Fax:951-461-7975
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASLP-A 8272355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant