Provider Demographics
NPI:1740432004
Name:GARVIN, JILL SUDY
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SUDY
Last Name:GARVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:BETH
Other - Last Name:SUDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:193 HUXLEY DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4815
Mailing Address - Country:US
Mailing Address - Phone:716-839-9278
Mailing Address - Fax:
Practice Address - Street 1:193 HUXLEY DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4815
Practice Address - Country:US
Practice Address - Phone:716-839-9278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007287235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist