Provider Demographics
NPI:1134491681
Name:BAXTER, JILLIAN PENLAND (MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:PENLAND
Last Name:BAXTER
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-7510
Mailing Address - Country:US
Mailing Address - Phone:828-361-5864
Mailing Address - Fax:
Practice Address - Street 1:4400 US HWY 64 ALT.
Practice Address - Street 2:SUITE D
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906
Practice Address - Country:US
Practice Address - Phone:828-516-1750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9590235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist