Provider Demographics
NPI:1366649055
Name:COUGLAR, JILL E (MA, SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:E
Last Name:COUGLAR
Suffix:
Gender:F
Credentials:MA, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 N ROGER WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-4225
Mailing Address - Country:US
Mailing Address - Phone:480-917-5840
Mailing Address - Fax:
Practice Address - Street 1:460 N ROGER WAY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-4225
Practice Address - Country:US
Practice Address - Phone:480-917-5840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0049235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ12003813OtherASHA