Provider Demographics
NPI:1275861189
Name:SCOTT-TRAINER, JILL J (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:J
Last Name:SCOTT-TRAINER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 SHABBONA LN
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1058
Mailing Address - Country:US
Mailing Address - Phone:630-699-5279
Mailing Address - Fax:630-297-7583
Practice Address - Street 1:4300 COMMERCE CT STE 300-10
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3709
Practice Address - Country:US
Practice Address - Phone:630-699-5279
Practice Address - Fax:630-297-7583
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0111731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12087907OtherCAQH