Provider Demographics
NPI:1285478537
Name:BOLAND, JILLIAN ALEXANDRA (AUD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:ALEXANDRA
Last Name:BOLAND
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HOSPITAL OVAL WEST
Mailing Address - Street 2:ROOM 430 CEDARWOOD HALL
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1571
Mailing Address - Country:US
Mailing Address - Phone:914-493-7294
Mailing Address - Fax:
Practice Address - Street 1:20 HOSPITAL OVAL W.
Practice Address - Street 2:CEDARWOOD HALL ROOM 430
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-493-7294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003287231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty