Provider Demographics
NPI:1770827305
Name:HERNANDEZ, JILL V (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:V
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 BELLINGTON CMN UNIT 2
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-7651
Mailing Address - Country:US
Mailing Address - Phone:925-980-4821
Mailing Address - Fax:
Practice Address - Street 1:224 BELLINGTON CMN UNIT 2
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-7651
Practice Address - Country:US
Practice Address - Phone:925-980-4821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist