Provider Demographics
NPI:1992358535
Name:REYNOLDS, JILLIAN (MS CCC-LSLP)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MS CCC-LSLP
Other - Prefix:
Other - First Name:JILLAIN
Other - Middle Name:
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-LSLP
Mailing Address - Street 1:4501 OLD SPARTANBURG RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-4105
Mailing Address - Country:US
Mailing Address - Phone:864-292-5154
Mailing Address - Fax:
Practice Address - Street 1:4501 OLD SPARTANBURG RD
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-4105
Practice Address - Country:US
Practice Address - Phone:864-292-5154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6418235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist