Provider Demographics
NPI:1619581907
Name:GREWAL, JILL ELIZABETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ELIZABETH
Last Name:GREWAL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:ELIZABETH
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1630 MIAMI CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-4528
Mailing Address - Country:US
Mailing Address - Phone:937-542-4290
Mailing Address - Fax:937-542-4291
Practice Address - Street 1:1630 MIAMI CHAPEL RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-4528
Practice Address - Country:US
Practice Address - Phone:937-542-4290
Practice Address - Fax:937-542-4291
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.14092235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist