Provider Demographics
NPI:1275600058
Name:TREALOUT, JILL (SA9191)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:TREALOUT
Suffix:
Gender:F
Credentials:SA9191
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7975 LAKE UNDERHILL RD
Mailing Address - Street 2:STE 300
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-6125
Mailing Address - Country:US
Mailing Address - Phone:407-303-6733
Mailing Address - Fax:407-303-6715
Practice Address - Street 1:7975 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8202
Practice Address - Country:US
Practice Address - Phone:407-303-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9191235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891664100Medicaid