Provider Demographics
NPI:1740459981
Name:CREACY, JILL E (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:E
Last Name:CREACY
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 1:4810 EAGLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8617
Mailing Address - Country:US
Mailing Address - Phone:336-665-1100
Mailing Address - Fax:
Practice Address - Street 1:3511 W MARKET ST STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-4442
Practice Address - Country:US
Practice Address - Phone:336-294-3338
Practice Address - Fax:336-294-6696
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist