Provider Demographics
NPI:1750545430
Name:GRUENWALD, JILL MARIE (AUD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARIE
Last Name:GRUENWALD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:BUCKINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1518231H00000X
TNAUD01518231H00000X
MN10021231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9205214OtherAETNA
TNP00634253OtherRR MEDICARE
TN1508515Medicaid
TN9205214OtherAETNA