Provider Demographics
NPI:1346932498
Name:SULLIVAN, JILL AMANDA (AUD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:AMANDA
Last Name:SULLIVAN
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 1:12309 N MOPAC EXPY STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2604
Mailing Address - Country:US
Mailing Address - Phone:512-339-4040
Mailing Address - Fax:512-339-1663
Practice Address - Street 1:4 LAKEWAY CENTRE CT UNIT B
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-2757
Practice Address - Country:US
Practice Address - Phone:512-682-4798
Practice Address - Fax:512-339-1663
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81519237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter