Provider Demographics
NPI:1285149039
Name:JILLA, ANNA MARIE (AUD, PHD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:MARIE
Last Name:JILLA
Suffix:
Gender:F
Credentials:AUD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10076
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77710-0076
Mailing Address - Country:US
Mailing Address - Phone:409-880-8171
Mailing Address - Fax:409-880-2265
Practice Address - Street 1:4942 ROLFE CHRISTOPHER DRIVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705
Practice Address - Country:US
Practice Address - Phone:409-880-8171
Practice Address - Fax:409-880-2265
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4726231H00000X
AL1186A231H00000X
LA9751231H00000X
TX81314231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist