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General NPI Number Information
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NPI Number | 1477950749
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Entity Type | Individual
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Provider Name | JILLIAN BLACK M.S., ED.S.
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Gender | Female
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 755 WESTERN ROW ROAD WESTERN ROW ELEMENTARY
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City | MASON
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State | OH
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Zip | 45040
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Country | US
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Telephone | 513-398-5821
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Fax |
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Provider Business Mailing Address
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Address Line | 6656 FOUNTAINS BLVD UNIT 7
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City | WEST CHESTER
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State | OH
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Zip | 45069-6128
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Country | US
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Telephone | 330-933-2766
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Fax |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 21027332
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License Number State | OH
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