Provider Demographics
NPI:1073939807
Name:PERRY, JILL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N EAST PROMONTORY STE 200
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2950
Mailing Address - Country:US
Mailing Address - Phone:801-844-1615
Mailing Address - Fax:
Practice Address - Street 1:375 N MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1278
Practice Address - Country:US
Practice Address - Phone:801-844-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker