Healthcare Provider Details

I. General information

NPI: 1346674173
Provider Name (Legal Business Name): JILLIAN HARNEY M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 AVIGNON DR
RIDGELAND MS
39157-5120
US

IV. Provider business mailing address

711 AVIGNON DR
RIDGELAND MS
39157-5120
US

V. Phone/Fax

Practice location:
  • Phone: 601-605-6777
  • Fax: 601-605-9907
Mailing address:
  • Phone: 601-605-6777
  • Fax: 601-605-9907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS3121
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: