Provider Demographics
NPI:1144750720
Name:COCHRANE, JILL M (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:COCHRANE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:COCHRANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:394 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2757
Mailing Address - Country:US
Mailing Address - Phone:917-647-9374
Mailing Address - Fax:
Practice Address - Street 1:394 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960
Practice Address - Country:US
Practice Address - Phone:917-647-9374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21725235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist