Provider Demographics
NPI:1538654181
Name:HOLLINGER, JILLIAN MEADWAY O'BRIEN
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MEADWAY O'BRIEN
Last Name:HOLLINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 SOUTH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2834
Mailing Address - Country:US
Mailing Address - Phone:315-529-3240
Mailing Address - Fax:
Practice Address - Street 1:590 FISHERS STATION DR STE 130
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9744
Practice Address - Country:US
Practice Address - Phone:585-924-7207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028755235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist