Basic Information
| Provider Information | |||||||||
| NPI: | 1063080869 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEMM | ||||||||
| FirstName: | JILLIAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S. CCC SLP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FRINK | ||||||||
| OtherFirstName: | JILLIAN | ||||||||
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| OtherCredential: | M.S. CCC SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6401 PARKHAVEN PL | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277123437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198165109 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 40 DUKE MEDICINE CIR # 1I | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277104000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196843859 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2021 | ||||||||
| LastUpdateDate: | 12/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.