Healthcare Provider Details

I. General information

NPI: 1952599631
Provider Name (Legal Business Name): JILL R SPECA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 DUNN RD STE 301
SAINT LOUIS MO
63136-6132
US

IV. Provider business mailing address

670 MASON RIDGE CENTER DR STE 300
SAINT LOUIS MO
63141-8573
US

V. Phone/Fax

Practice location:
  • Phone: 314-953-8250
  • Fax: 314-953-8255
Mailing address:
  • Phone: 314-953-8250
  • Fax: 314-953-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2017017216
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085003089
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: