Provider Demographics
NPI:1861826653
Name:DETWILER, JILLIAN LEIGH (AUD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:LEIGH
Last Name:DETWILER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N STONEWALL AVE
Mailing Address - Street 2:THE UNIVERISTY OF TULSA- MARY K CHAPMAN CENTER
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1215
Mailing Address - Country:US
Mailing Address - Phone:405-271-2866
Mailing Address - Fax:
Practice Address - Street 1:1200 N STONEWALL AVE
Practice Address - Street 2:THE UNIVERISTY OF TULSA- MARY K CHAPMAN CENTER
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1215
Practice Address - Country:US
Practice Address - Phone:405-271-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4137231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist