MEDICARE: DR. JILLIAN S ANDERSEN AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	853	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000	OTHER		N/A

General Provider Information

NPI Number	:	1528588209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILLIAN S ANDERSEN AU.D.

Provider Business Mailing Address
First Line	:	7850 VANCE DR STE 195
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80003-2132
Country	:	US
Telephone Number	:	303-432-3601
Fax Number	:	303-432-3623

Provider Business Practice Location Address
First Line	:	7850 VANCE DR STE 195
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80003-2132
Country	:	US
Telephone Number	:	303-432-3601
Fax Number	:	303-432-3623

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2017
Last Update Date	:	08/02/2022

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