Provider Demographics
NPI:1184199077
Name:PIERCE, JILL ANN (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 STONE CLIFF LN
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-6082
Mailing Address - Country:US
Mailing Address - Phone:216-702-4144
Mailing Address - Fax:
Practice Address - Street 1:5515 CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-7521
Practice Address - Country:US
Practice Address - Phone:803-810-8548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5534235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist