Provider Demographics
NPI:1154429207
Name:ANDREWS, JILL (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DEPOT ROAD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105
Mailing Address - Country:US
Mailing Address - Phone:207-781-8881
Mailing Address - Fax:207-781-8855
Practice Address - Street 1:50 DEPOT ROAD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105
Practice Address - Country:US
Practice Address - Phone:207-781-8881
Practice Address - Fax:207-781-8855
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME334790000Medicaid
ME7923711OtherAETNA
ME079017OtherANTHEM