Provider Demographics
NPI:1003025008
Name:STANGER, JILL MARIE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:STANGER
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:ROOTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-541-2500
Mailing Address - Fax:952-541-2539
Practice Address - Street 1:1665 UTICA AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:952-541-2500
Practice Address - Fax:952-541-2539
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1535106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN326922000Medicaid