Provider Demographics
NPI:1174079263
Name:EILAND, JILLIAN CAMILLE BATES
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:CAMILLE BATES
Last Name:EILAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 VILLA DI ESTE TER UNIT 213
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1650
Mailing Address - Country:US
Mailing Address - Phone:727-252-4794
Mailing Address - Fax:
Practice Address - Street 1:756 N SUN DR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2507
Practice Address - Country:US
Practice Address - Phone:727-252-4794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2017-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 7781235Z00000X
FLSA15624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist