Provider Demographics
NPI:1851639256
Name:YAW CHING, JILLIAN ROSE
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:ROSE
Last Name:YAW CHING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 NW 129TH WAY
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2979
Mailing Address - Country:US
Mailing Address - Phone:954-258-3611
Mailing Address - Fax:
Practice Address - Street 1:1381 NW 129TH WAY
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2979
Practice Address - Country:US
Practice Address - Phone:954-258-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-21
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6128235Z00000X
FLSA12756235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist