Healthcare Provider Details

I. General information

NPI: 1720561533
Provider Name (Legal Business Name): JILL KNEEMILLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2018
Last Update Date: 09/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 WOODLAWN AVE STE 15
O FALLON MO
63366-7647
US

IV. Provider business mailing address

9 LONG BRANCH CT
SAINT PETERS MO
63376-2610
US

V. Phone/Fax

Practice location:
  • Phone: 636-379-1779
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2013026548
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: