Provider Demographics
NPI:1376321893
Name:DELEO, JILLIAN RAE
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:RAE
Last Name:DELEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2065
Mailing Address - Country:US
Mailing Address - Phone:856-745-6048
Mailing Address - Fax:
Practice Address - Street 1:569 ABBINGTON DR
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-5800
Practice Address - Country:US
Practice Address - Phone:856-745-6048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
41YS01218600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist