Provider Demographics
NPI:1700320686
Name:JASIE, JILLIAN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:JASIE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:FIORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 EDGEWORTH RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1612
Mailing Address - Country:US
Mailing Address - Phone:617-690-7490
Mailing Address - Fax:
Practice Address - Street 1:33 EDGEWORTH RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-1612
Practice Address - Country:US
Practice Address - Phone:617-690-7490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10011235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist