Provider Demographics
NPI:1760934152
Name:TUTLE, JILLIAN QUINN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:QUINN
Last Name:TUTLE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:701 HIGHWAY 352 STE A
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-6898
Mailing Address - Country:US
Mailing Address - Phone:214-500-4556
Mailing Address - Fax:
Practice Address - Street 1:701 HIGHWAY 352 STE A
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6898
Practice Address - Country:US
Practice Address - Phone:214-500-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist