Provider Demographics
NPI:1407377880
Name:ALLEN, JILLIAN SHEEHY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:SHEEHY
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:LILE
Other - Last Name:SHEEHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:40 MULLINS BOG W
Mailing Address - Street 2:
Mailing Address - City:LINCOLNVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04849
Mailing Address - Country:US
Mailing Address - Phone:281-814-6917
Mailing Address - Fax:
Practice Address - Street 1:91 CAMDEN ST STE 108
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2430
Practice Address - Country:US
Practice Address - Phone:207-594-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113502235Z00000X
MESP3922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist