Provider Demographics
NPI:1174788392
Name:FIRSZT, JILL BLAIR (AUD)
Entity type:Individual
Prefix:MR
First Name:JILL
Middle Name:BLAIR
Last Name:FIRSZT
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8115
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-7245
Mailing Address - Fax:314-747-5593
Practice Address - Street 1:517 S EUCLID AVE
Practice Address - Street 2:10TH FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1007
Practice Address - Country:US
Practice Address - Phone:314-362-7245
Practice Address - Fax:314-747-5593
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005040720231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist