Provider Demographics
NPI:1275257412
Name:HORD, JILL M (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:M
Last Name:HORD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 STAFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7246
Mailing Address - Country:US
Mailing Address - Phone:540-658-6210
Mailing Address - Fax:
Practice Address - Street 1:101 SPARTAN DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-5453
Practice Address - Country:US
Practice Address - Phone:540-658-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202010606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist