Provider Demographics
NPI:1972161396
Name:GRIFFITH, JILLIAN (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 TERHUNE RD SE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3644
Mailing Address - Country:US
Mailing Address - Phone:706-266-2806
Mailing Address - Fax:
Practice Address - Street 1:910 COMPASSION CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1645
Practice Address - Country:US
Practice Address - Phone:907-212-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0003238235Z00000X
CA27523235Z00000X
AK146856235Z00000X
GASLP010111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist