Provider Demographics
NPI:1710587886
Name:FROST, JILL (MCD, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:MCD, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7607 FERN AVE STE 704
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5744
Mailing Address - Country:US
Mailing Address - Phone:318-828-1450
Mailing Address - Fax:318-828-2697
Practice Address - Street 1:2122 AIRLINE DR STE 200
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3270
Practice Address - Country:US
Practice Address - Phone:318-828-1450
Practice Address - Fax:318-828-2697
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3337235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist