Basic Information
Provider Information
NPI: 1861577363
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHANDLER
FirstName: JILL
MiddleName: KAY
NamePrefix: MS.
NameSuffix:  
Credential: M.S.-C.C.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: GREEN
OtherFirstName: JILL
OtherMiddleName: K
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 8431 FREDERICKSBURG RD
Address2: FL 1
City: SAN ANTONIO
State: TX
PostalCode: 782093729
CountryCode: US
TelephoneNumber: 2104504621
FaxNumber:  
Practice Location
Address1: 8300 FLOYD CURL DR
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782293931
CountryCode: US
TelephoneNumber: 2104509000
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/25/2006
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X24506TXY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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