Healthcare Provider Details

I. General information

NPI: 1447726914
Provider Name (Legal Business Name): JILLIAN APRIL MARLER SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6104 MAPLE GROVE WAY
NOBLESVILLE IN
46062-6467
US

IV. Provider business mailing address

6104 MAPLE GROVE WAY
NOBLESVILLE IN
46062-6467
US

V. Phone/Fax

Practice location:
  • Phone: 765-251-1567
  • Fax:
Mailing address:
  • Phone: 765-251-1567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number22005821A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: