Doctor Name: | JILLIAN DOHERTY |
NPI Number: | 1114273299 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. SLP CCC |
License Number: | 146011217 |
Business Practice Address: | 19740 Governors Hwy Ste 118 Flossmoor, IL - 604222085 |
Business Phone Number: | 7087995569 |
Business Fax Number: | |
Mailing Address: | 19740 Governors Hwy Ste 118, FLOSSMOOR |
State: | IL |
Postal Code: | 604222085 |
Phone Number: | 7087995569 |
Fax Number: | |
NPI Enumeration Date: | 07/26/2012 |
NPI Last Update Date: | 07/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 146011217 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |