Provider Demographics
NPI:1134646649
Name:MCCORKLE, JILL (MA/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MCCORKLE
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20501 S SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-9020
Mailing Address - Country:US
Mailing Address - Phone:816-892-1534
Mailing Address - Fax:
Practice Address - Street 1:20501 S SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PECULIAR
Practice Address - State:MO
Practice Address - Zip Code:64078-9020
Practice Address - Country:US
Practice Address - Phone:816-892-1534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist