Provider Demographics
NPI:1093717753
Name:STRUNK, JILL MARIE (EDD, LP)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARIE
Last Name:STRUNK
Suffix:
Gender:F
Credentials:EDD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 HUNTINGDON DR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5116
Mailing Address - Country:US
Mailing Address - Phone:952-936-7540
Mailing Address - Fax:
Practice Address - Street 1:4001 HUNTINGDON DR
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5116
Practice Address - Country:US
Practice Address - Phone:952-936-7547
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3934103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical