Provider Demographics
NPI:1427340413
Name:BIRCH, JILLIAN ELAINE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:ELAINE
Last Name:BIRCH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6298 VETERANS PKWY STE 5A
Mailing Address - Street 2:POST OFFICE BOX 8068
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-6245
Mailing Address - Country:US
Mailing Address - Phone:706-322-7762
Mailing Address - Fax:706-327-6157
Practice Address - Street 1:2515 DOUBLE CHURCHES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2742
Practice Address - Country:US
Practice Address - Phone:706-660-5495
Practice Address - Fax:706-660-5497
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7552235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist