1497952279 NPI number — MRS. JILLIAN MARE W. CHAMBERLAIN M.A., SLP

Table of content: MRS. JILLIAN MARE W. CHAMBERLAIN M.A., SLP (NPI 1497952279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497952279 NPI number — MRS. JILLIAN MARE W. CHAMBERLAIN M.A., SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAMBERLAIN
Provider First Name:
JILLIAN
Provider Middle Name:
MARE W.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALIEZER
Provider Other First Name:
JILLIAN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497952279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70704 E 715 PR NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99352-7701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-430-3770
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 W LEWIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-5472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-543-6700
Provider Business Practice Location Address Fax Number:
509-543-6728
Provider Enumeration Date:
06/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  LL60011776 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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