Provider Demographics
NPI:1184979536
Name:EMERSON, JILLIAN JOHNSON (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:JOHNSON
Last Name:EMERSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 OAKHILL RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-7467
Mailing Address - Country:US
Mailing Address - Phone:205-387-0564
Mailing Address - Fax:205-387-0568
Practice Address - Street 1:2110 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2208
Practice Address - Country:US
Practice Address - Phone:931-455-5189
Practice Address - Fax:931-393-2455
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3182235Z00000X
TN6530235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist