Provider Demographics
NPI:1063756476
Name:GRADZKI, JILLIAN C (MS CF- SLP)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:C
Last Name:GRADZKI
Suffix:
Gender:F
Credentials:MS CF- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 KNOLLWOOD TER
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-2334
Mailing Address - Country:US
Mailing Address - Phone:201-563-7393
Mailing Address - Fax:
Practice Address - Street 1:165 CHANGEBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9563
Practice Address - Country:US
Practice Address - Phone:973-299-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-2087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist