Provider Demographics
NPI:1548475460
Name:JAKLE, JILL MARIE (BS ED)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:JAKLE
Suffix:
Gender:F
Credentials:BS ED
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS ED
Mailing Address - Street 1:34 NORTHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-7004
Mailing Address - Country:US
Mailing Address - Phone:978-927-3658
Mailing Address - Fax:
Practice Address - Street 1:103 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-4001
Practice Address - Country:US
Practice Address - Phone:781-593-2727
Practice Address - Fax:781-593-2524
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist