Provider Demographics
NPI:1972727113
Name:JEUDE, JILL ELAINE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ELAINE
Last Name:JEUDE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:COREA
Mailing Address - State:ME
Mailing Address - Zip Code:04624-0111
Mailing Address - Country:US
Mailing Address - Phone:573-366-7688
Mailing Address - Fax:
Practice Address - Street 1:174 PAUL BUNYAN ROAD
Practice Address - Street 2:
Practice Address - City:COREA
Practice Address - State:ME
Practice Address - Zip Code:04624-0462
Practice Address - Country:US
Practice Address - Phone:573-366-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1871101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495933814Medicaid