Provider Demographics
NPI:1205969912
Name:CHIMKA, JILL BUNZENDAHL (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:BUNZENDAHL
Last Name:CHIMKA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:ANNETTE
Other - Last Name:BUNZENDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2800 13TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-5318
Mailing Address - Country:US
Mailing Address - Phone:202-387-4434
Mailing Address - Fax:202-462-7379
Practice Address - Street 1:2800 13TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-5318
Practice Address - Country:US
Practice Address - Phone:202-387-4434
Practice Address - Fax:202-462-7379
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC029979300Medicaid