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NPI Code Detail

MEDICARE: MISS JILLIAN MARIE BOCCARDO MA, CCC-SLP

MEDICARE: MISS JILLIAN MARIE BOCCARDO MA, CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSP18272CA

General Provider Information

NPI Number : 1063651255
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JILLIAN MARIE BOCCARDO MA, CCC-SLP
Provider Business Mailing Address
First Line : 4675 VIA LOS SANTOS
Second Line :
City : SANTA BARBARA
State : CA
Zip : 93111-1346
Country : US
Telephone Number : 805-964-2700
Fax Number : 805-964-2722
Provider Business Practice Location Address
First Line : 4675 VIA LOS SANTOS
Second Line :
City : SANTA BARBARA
State : CA
Zip : 93111-1346
Country : US
Telephone Number : 805-964-2700
Fax Number : 805-964-2722
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2009
Last Update Date : 01/08/2019

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