MEDICARE: JILLIAN HENDRICKS M.A. 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
1	252Y00000X	Early Intervention Provider Agency	SL013360	PA

General Provider Information

NPI Number	:	1306488432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN HENDRICKS M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	2017 S COLORADO ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2911
Country	:	US
Telephone Number	:	267-664-9135
Fax Number	:

Provider Business Practice Location Address
First Line	:	2017 S COLORADO ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2911
Country	:	US
Telephone Number	:	267-664-9135
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2019
Last Update Date	:	10/09/2019

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