Provider Demographics
NPI:1205974763
Name:ASKERLULND, JILLENE LOUISE (SA-C)
Entity type:Individual
Prefix:
First Name:JILLENE
Middle Name:LOUISE
Last Name:ASKERLULND
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:SANTAQUIN
Mailing Address - State:UT
Mailing Address - Zip Code:84655-0445
Mailing Address - Country:US
Mailing Address - Phone:801-472-8715
Mailing Address - Fax:
Practice Address - Street 1:650 E 450 S
Practice Address - Street 2:
Practice Address - City:SANTAQUIN
Practice Address - State:UT
Practice Address - Zip Code:84655-8062
Practice Address - Country:US
Practice Address - Phone:801-472-8715
Practice Address - Fax:801-754-3677
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT02-231174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist