Provider Demographics
NPI:1447681929
Name:EHLERS, JILL
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:EHLERS
Suffix:
Gender:F
Credentials:
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 69
Mailing Address - Street 2:310 4TH ST.
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674
Mailing Address - Country:US
Mailing Address - Phone:360-225-9443
Mailing Address - Fax:
Practice Address - Street 1:406 NW 85TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-7728
Practice Address - Country:US
Practice Address - Phone:503-970-6520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13619235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist