Provider Demographics
NPI:1720766595
Name:KEMMERLY, JILLIAN
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:
Last Name:KEMMERLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 KENNETH DR
Mailing Address - Street 2:
Mailing Address - City:LEOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17540-9007
Mailing Address - Country:US
Mailing Address - Phone:717-951-3479
Mailing Address - Fax:
Practice Address - Street 1:1389 SNYDER CORNER RD
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-7837
Practice Address - Country:US
Practice Address - Phone:717-951-3479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSL001994235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist