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General NPI Number Information
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NPI Number | 1063651255
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Entity Type | Individual
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Provider Name | JILLIAN MARIE BOCCARDO MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 4675 VIA LOS SANTOS
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City | SANTA BARBARA
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State | CA
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Zip | 93111-1346
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Country | US
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Telephone | 805-964-2700
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Fax | 805-964-2722
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Provider Business Mailing Address
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Address Line | 4675 VIA LOS SANTOS
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City | SANTA BARBARA
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State | CA
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Zip | 93111-1346
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Country | US
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Telephone | 805-964-2700
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Fax | 805-964-2722
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP18272
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License Number State | CA
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