Individual
MRS. JILLIAN MARIA BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLPA
Contact information
Practice address
2404 DESPERADO DR, TRINIDAD, CO 81082-3966
(719) 680-2015
Mailing address
2404 DESPERADO DR, TRINIDAD, CO 81082-3966
(719) 680-2015
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
358258
CO
Other
Enumeration date
09/01/2021
Last updated
09/01/2021
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