Provider Demographics
NPI:1558592683
Name:ALVARADO, JILL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 WEDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-1507
Mailing Address - Country:US
Mailing Address - Phone:678-476-5371
Mailing Address - Fax:
Practice Address - Street 1:1013 WEDGEWOOD CT
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-1507
Practice Address - Country:US
Practice Address - Phone:678-476-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA09130925235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist