Healthcare Provider Details

I. General information

NPI: 1013843119
Provider Name (Legal Business Name): JILLIAN FLINT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2049 GEORGE URBAN BLVD
DEPEW NY
14043-1823
US

IV. Provider business mailing address

70 CUNARD RD LOWR
BUFFALO NY
14216-1917
US

V. Phone/Fax

Practice location:
  • Phone: 716-901-8700
  • Fax:
Mailing address:
  • Phone: 315-777-7348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: