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General NPI Number Information
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NPI Number | 1861310534
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Entity Type | Individual
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Provider Name | JILLIAN BACCHUS
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Gender | Female
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Dates
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Enumeration Date | 07/09/2026
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Last Update Date | 08/12/2026
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Provider Practice Location Address
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Address Line | 1510 E HARDING ST
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City | MORRILTON
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State | AR
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Zip | 72110-1540
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Country | US
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Telephone | 870-351-8201
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Fax |
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Provider Business Mailing Address
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Address Line | 365 COUNTY ROAD 1699
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City | KNOXVILLE
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State | AR
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Zip | 72845-8563
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Country | US
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Telephone | 870-351-8201
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 203656
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License Number State | AR
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