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NPI Code Detail

MEDICARE: MS. JILLIAN K WOOLARD B.C.B.A.

MEDICARE: MS. JILLIAN K WOOLARD B.C.B.A.
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
1103K00000XBehavioral Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-09-5778OTHERBEHAVIOR ANALYST CERTIFICATION BOARD

General Provider Information

NPI Number : 1669611695
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JILLIAN K WOOLARD B.C.B.A.
Provider Business Mailing Address
First Line : 640 W CORNELIA AVE
Second Line : 3W
City : CHICAGO
State : IL
Zip : 60657-2534
Country : US
Telephone Number : 804-304-1570
Fax Number :
Provider Business Practice Location Address
First Line : 1790 SW 43RD WAY
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33317-5701
Country : US
Telephone Number : 855-442-2454
Fax Number : 954-206-7699
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2009
Last Update Date : 12/04/2017

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