Provider Demographics
NPI:1497996979
Name:HULETT, JILL (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:HULETT
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 1:401 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BROADALBIN
Mailing Address - State:NY
Mailing Address - Zip Code:12025-2070
Mailing Address - Country:US
Mailing Address - Phone:518-774-5915
Mailing Address - Fax:
Practice Address - Street 1:401 RIDGE RD
Practice Address - Street 2:
Practice Address - City:BROADALBIN
Practice Address - State:NY
Practice Address - Zip Code:12025-2070
Practice Address - Country:US
Practice Address - Phone:518-774-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014687235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist