Provider Demographics
NPI:1154091239
Name:ANDREYCHAK, JILL (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:ANDREYCHAK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 LEXINGTON CT
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1367
Mailing Address - Country:US
Mailing Address - Phone:609-271-8833
Mailing Address - Fax:
Practice Address - Street 1:1515 SHORE RD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2349
Practice Address - Country:US
Practice Address - Phone:856-810-7599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ788438235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist