Provider Demographics
NPI:1356995963
Name:TAYLOR, JILL HENDERSON (CF-SLP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:HENDERSON
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARI
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5327 LEMONA AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-3950
Mailing Address - Country:US
Mailing Address - Phone:310-903-2816
Mailing Address - Fax:
Practice Address - Street 1:5930 ADOBE RD
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-2356
Practice Address - Country:US
Practice Address - Phone:760-367-1743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13663235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist