Provider Demographics
NPI:1982017331
Name:CARROLL, JILLIAN HARRISON (CF-SLP)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:HARRISON
Last Name:CARROLL
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 W MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5921
Mailing Address - Country:US
Mailing Address - Phone:870-734-6348
Mailing Address - Fax:
Practice Address - Street 1:4408 W WALNUT ST
Practice Address - Street 2:STE 7
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-9526
Practice Address - Country:US
Practice Address - Phone:479-246-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8822235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist