Provider Demographics
NPI:1174959068
Name:SMITH, JILLIAN MARIE (AUD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:JILLIAN
Other - Middle Name:MARIE
Other - Last Name:SIMISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:2022 BEECH ST
Mailing Address - Street 2:APT 204
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-5990
Mailing Address - Country:US
Mailing Address - Phone:317-709-5828
Mailing Address - Fax:
Practice Address - Street 1:2802 LEONARD DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-7136
Practice Address - Country:US
Practice Address - Phone:219-531-0625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist