Provider Demographics
NPI:1679001481
Name:BACHURSKI, JILL MORGAN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MORGAN
Last Name:BACHURSKI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 S COLUMBUS BLVD UNIT 29
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3517
Mailing Address - Country:US
Mailing Address - Phone:267-371-9796
Mailing Address - Fax:
Practice Address - Street 1:740 S COLUMBUS BLVD UNIT 29
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-3517
Practice Address - Country:US
Practice Address - Phone:267-371-9796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013317235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist