Provider Demographics
NPI:1245427129
Name:WEIS, JILLIAN MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MARIE
Last Name:WEIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MAXWELL AVE APT #19
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4169
Mailing Address - Country:US
Mailing Address - Phone:443-614-3519
Mailing Address - Fax:
Practice Address - Street 1:1333 IRIS AVE
Practice Address - Street 2:MENTAL HEALTH CENTER OF BOULDER CTY INC
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2296
Practice Address - Country:US
Practice Address - Phone:443-614-3519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker