Individual
JILLIAN N. HAZELBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
2030 CHILHOWEE MEDICAL PARK, MARYVILLE, TN 37804-5285
(865) 982-3400
(865) 238-2034
Mailing address
PO BOX 5209, MARYVILLE, TN 37802-5209
(865) 982-3400
(865) 238-2034
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
22005131A
IN
235Z00000X
Speech-Language Pathologist
4174
KY
235Z00000X
Speech-Language Pathologist
Primary
5923
TN
235Z00000X
Speech-Language Pathologist
SP-10021
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1564187
—
OH
Enumeration date
10/10/2011
Last updated
09/13/2016
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