Provider Demographics
NPI:1699234765
Name:MCKILLOP, JENNIFER RENEE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENEE
Last Name:MCKILLOP
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:RENEE
Other - Last Name:BUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CF-SLP
Mailing Address - Street 1:630 S BENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1752
Mailing Address - Country:US
Mailing Address - Phone:724-504-0152
Mailing Address - Fax:
Practice Address - Street 1:105 BURGESS DR
Practice Address - Street 2:
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-1597
Practice Address - Country:US
Practice Address - Phone:724-452-3580
Practice Address - Fax:724-452-3407
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist