Provider Demographics
NPI:1598585606
Name:BURKE, JILLIAN ELAINE (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:ELAINE
Last Name:BURKE
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 1:906 CARTHAGE WAY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-6551
Mailing Address - Country:US
Mailing Address - Phone:817-235-9103
Mailing Address - Fax:
Practice Address - Street 1:1016 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1745
Practice Address - Country:US
Practice Address - Phone:817-235-9103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121374235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist