Provider Demographics
NPI:1134491681
Name:PENLAND, JILLIAN PAIGE (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:PAIGE
Last Name:PENLAND
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 1:1523 NEW GARDEN RD
Mailing Address - Street 2:APT. 2E
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-1578
Mailing Address - Country:US
Mailing Address - Phone:828-361-5864
Mailing Address - Fax:
Practice Address - Street 1:5603 W FRIENDLY AVE STE B
Practice Address - Street 2:#274
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4252
Practice Address - Country:US
Practice Address - Phone:336-790-0271
Practice Address - Fax:336-740-9099
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9590235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist