Provider Demographics
NPI:1942623590
Name:AUCHLY, JILL (MA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:AUCHLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 PRAIRIE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MO
Mailing Address - Zip Code:63366-4634
Mailing Address - Country:US
Mailing Address - Phone:314-605-3830
Mailing Address - Fax:
Practice Address - Street 1:1 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3415
Practice Address - Country:US
Practice Address - Phone:636-327-3800
Practice Address - Fax:636-327-8611
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013028765235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1942334289Medicaid