Provider Demographics
NPI:1669611695
Name:WOOLARD, JILLIAN K (BCBA)
Entity type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:K
Last Name:WOOLARD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 W CORNELIA AVE
Mailing Address - Street 2:3W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2534
Mailing Address - Country:US
Mailing Address - Phone:804-304-1570
Mailing Address - Fax:
Practice Address - Street 1:1790 SW 43RD WAY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33317-5701
Practice Address - Country:US
Practice Address - Phone:855-442-2454
Practice Address - Fax:954-206-7699
Is Sole Proprietor?:No
Enumeration Date:2009-02-15
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-09-5778OtherBEHAVIOR ANALYST CERTIFICATION BOARD