Individual
DR. JILLIAN L CHILDRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
13101 BRUCE B DOWNS BLVD, TAMPA, FL 33612-3803
(813) 974-1189
(813) 558-1343
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 974-2201
(813) 974-2812
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PY8272
FL
103TS0200X
School Psychologist
Primary
PY8272
FL
222Q00000X
Developmental Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
593P1
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/17/2007
Last updated
02/18/2021
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