Provider Demographics
NPI:1669482691
Name:GOLDER, JILLIAN KATHRINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:KATHRINE
Last Name:GOLDER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:JILLIAN
Other - Middle Name:KATHRINE
Other - Last Name:BOGGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 37092
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-7092
Mailing Address - Country:US
Mailing Address - Phone:520-818-1646
Mailing Address - Fax:
Practice Address - Street 1:SOUTHERN ARIZONA VA HEALTH CARE SYSTEM
Practice Address - Street 2:3601 S. 6TH AVE.
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-0001
Practice Address - Country:US
Practice Address - Phone:520-792-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4168235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist