Provider Demographics
NPI:1649530452
Name:GILLIAM, JANITA R (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JANITA
Middle Name:R
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:JANITA
Other - Middle Name:S
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:1720 RANCH TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1462
Mailing Address - Country:US
Mailing Address - Phone:773-844-4361
Mailing Address - Fax:
Practice Address - Street 1:1231 GREENWAY DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2531
Practice Address - Country:US
Practice Address - Phone:972-871-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-26
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist