Provider Demographics
NPI:1326233032
Name:LILES, JAN C (AUD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:C
Last Name:LILES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8075 MADISON BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2041
Mailing Address - Country:US
Mailing Address - Phone:256-319-4327
Mailing Address - Fax:256-461-1228
Practice Address - Street 1:8075 MADISON BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2041
Practice Address - Country:US
Practice Address - Phone:256-319-4327
Practice Address - Fax:256-461-1228
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL695A231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009978130Medicaid
AL51506305LILOtherBLUE CROSS BLUE SHIELD
AL51506305LILOtherBLUE CROSS BLUE SHIELD