Provider Demographics
NPI:1447791710
Name:FROST, JILLIAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 PLEASANT STREET
Mailing Address - Street 2:SOUTH 2 ROOM 236
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1406
Mailing Address - Country:US
Mailing Address - Phone:515-241-6228
Mailing Address - Fax:515-241-8685
Practice Address - Street 1:2720 8TH ST SW STE B
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009
Practice Address - Country:US
Practice Address - Phone:515-957-8609
Practice Address - Fax:515-957-9264
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9833235Z00000X
IA085848235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist