Provider Demographics
NPI:1295852671
Name:HILLER, JAY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JAY
Middle Name:
Last Name:HILLER
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 1:11108 RIO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-1375
Mailing Address - Country:US
Mailing Address - Phone:512-335-7935
Mailing Address - Fax:
Practice Address - Street 1:11108 RIO VISTA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-1375
Practice Address - Country:US
Practice Address - Phone:512-335-7935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14163235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist