Provider Demographics
NPI:1871062232
Name:ROACH, JILL ANNE (M ED CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANNE
Last Name:ROACH
Suffix:
Gender:F
Credentials:M ED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13416 BURNT WOODS PL
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3920
Mailing Address - Country:US
Mailing Address - Phone:301-540-0739
Mailing Address - Fax:
Practice Address - Street 1:13416 BURNT WOODS PL
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-3920
Practice Address - Country:US
Practice Address - Phone:301-540-0739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04519235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist