Individual
MRS. JILL MICHELLE WALCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
500 7TH AVE S, ST PETERSBURG, FL 33701-4820
(727) 767-4403
(727) 767-4715
Mailing address
945 28TH ST N, ST PETERSBURG, FL 33713-6737
(727) 368-6271
(727) 368-6271
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
766932100
—
FL
Enumeration date
02/13/2007
Last updated
07/09/2007
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