Provider Demographics
NPI:1003951781
Name:CRESWELL, JILL L (MS)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:L
Last Name:CRESWELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:LISA
Other - Last Name:KILIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:162 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-2896
Mailing Address - Country:US
Mailing Address - Phone:802-223-6946
Mailing Address - Fax:
Practice Address - Street 1:162 ELM ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-0000
Practice Address - Country:US
Practice Address - Phone:802-223-6946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT47-0000571103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1004004Medicaid