Provider Demographics
NPI:1376967349
Name:MARSHALL, JILLIAN GRACE (AUD,)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:GRACE
Last Name:MARSHALL
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 1:2017 W I 35 FRONTAGE RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8504
Mailing Address - Country:US
Mailing Address - Phone:405-757-3510
Mailing Address - Fax:405-757-3511
Practice Address - Street 1:2017 W I 35 FRONTAGE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-8504
Practice Address - Country:US
Practice Address - Phone:405-757-3510
Practice Address - Fax:405-757-3511
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80488231H00000X
OK4471231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist