MEDICARE: MISS JILLIAN COLLEEN COLON M.S., CCC-SLP

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	235Z00000X	Speech-Language Pathologist	4317	MS

General Provider Information

NPI Number	:	1649071911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JILLIAN COLLEEN COLON M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	300 UNION ST
Second Line	:
City	:	BAY SAINT LOUIS
State	:	MS
Zip	:	39520-4447
Country	:	US
Telephone Number	:	703-463-7684
Fax Number	:	228-214-3262

Provider Business Practice Location Address
First Line	:	300 UNION ST
Second Line	:
City	:	BAY SAINT LOUIS
State	:	MS
Zip	:	39520-4447
Country	:	US
Telephone Number	:	703-463-7684
Fax Number	:	228-214-3262

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

Provider Enumeration Date	:	03/22/2025
Last Update Date	:	03/22/2025

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Directions to “ MISS JILLIAN COLLEEN COLON M.S., CCC-SLP” Practice Location

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