Provider Demographics
NPI:1063080869
Name:KLEMM, JILLIAN (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:KLEMM
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:FRINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:6401 PARKHAVEN PL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-3437
Mailing Address - Country:US
Mailing Address - Phone:919-816-5109
Mailing Address - Fax:
Practice Address - Street 1:40 DUKE MEDICINE CIR # 1I
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-4000
Practice Address - Country:US
Practice Address - Phone:919-684-3859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist