Provider Demographics
NPI:1699571885
Name:MAUDE, JILL M
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:MAUDE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 WOODRUFF PLACE EAST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-1920
Mailing Address - Country:US
Mailing Address - Phone:317-000-0000
Mailing Address - Fax:
Practice Address - Street 1:656 WOODRUFF PLACE EAST DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-1920
Practice Address - Country:US
Practice Address - Phone:317-000-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter