Provider Demographics
NPI:1629207311
Name:PALAZZO, JILL DENISE (MACCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:DENISE
Last Name:PALAZZO
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4385 MOTORWAY DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3451
Mailing Address - Country:US
Mailing Address - Phone:248-681-8571
Mailing Address - Fax:248-681-8571
Practice Address - Street 1:4385 MOTORWAY DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3451
Practice Address - Country:US
Practice Address - Phone:248-681-8571
Practice Address - Fax:248-681-8571
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00942185235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist