Provider Demographics
NPI:1376929513
Name:BEUCKENS, JILL MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:BEUCKENS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1104 7TH AVE S
Mailing Address - Street 2:MSUM BOX 119
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56563-0001
Mailing Address - Country:US
Mailing Address - Phone:218-477-2330
Mailing Address - Fax:218-477-4392
Practice Address - Street 1:1104 7TH AVE S
Practice Address - Street 2:MSUM BOX 119
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56563-0001
Practice Address - Country:US
Practice Address - Phone:218-477-2330
Practice Address - Fax:218-477-4392
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist