Provider Demographics
NPI:1548052954
Name:IVEY, JILLIAN
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:IVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 LAURIE LN
Mailing Address - Street 2:
Mailing Address - City:HUGHESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18640-2815
Mailing Address - Country:US
Mailing Address - Phone:570-417-5394
Mailing Address - Fax:570-417-5394
Practice Address - Street 1:312 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1555
Practice Address - Country:US
Practice Address - Phone:570-947-8103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007965235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist