Basic Information
| Provider Information | |||||||||
| NPI: | 1538496542 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUNDSCHUH | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A. CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2517 MENTOR PL | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631442129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142361062 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7733 FORSYTH BLVD | ||||||||
| Address2: | SUITE 2300 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631051817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006771238 | ||||||||
| FaxNumber: | 3148630769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2009 | ||||||||
| LastUpdateDate: | 11/11/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2001005569 | MO | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.