Provider Demographics
NPI:1497952279
Name:CHAMBERLAIN, JILLIAN MARE W (MA, SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:MARE W
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:MISS
Other - First Name:JILLIAN
Other - Middle Name:M
Other - Last Name:WALIEZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:70704 E 715 PR NE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7701
Mailing Address - Country:US
Mailing Address - Phone:360-430-3770
Mailing Address - Fax:
Practice Address - Street 1:1215 W LEWIS ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5472
Practice Address - Country:US
Practice Address - Phone:509-543-6700
Practice Address - Fax:509-543-6728
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60011776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist