Provider Demographics
NPI:1538496542
Name:BUNDSCHUH, JILL RENEE (MA CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:RENEE
Last Name:BUNDSCHUH
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2517 MENTOR PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2129
Mailing Address - Country:US
Mailing Address - Phone:314-236-1062
Mailing Address - Fax:
Practice Address - Street 1:7733 FORSYTH BLVD
Practice Address - Street 2:SUITE 2300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1817
Practice Address - Country:US
Practice Address - Phone:800-677-1238
Practice Address - Fax:314-863-0769
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001005569235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist