Provider Demographics
NPI:1861965360
Name:RENSCHLER, JILLIAN QUILLEN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:QUILLEN
Last Name:RENSCHLER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5231 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-1834
Mailing Address - Country:US
Mailing Address - Phone:765-914-7384
Mailing Address - Fax:
Practice Address - Street 1:7440 HAGUE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1930
Practice Address - Country:US
Practice Address - Phone:317-762-8449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006951A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist