Provider Demographics
NPI:1316218944
Name:SAMMON, JILLIAN ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:ELIZABETH
Last Name:SAMMON
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 1:15 SW COLORADO AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1150
Mailing Address - Country:US
Mailing Address - Phone:541-647-0514
Mailing Address - Fax:541-408-9016
Practice Address - Street 1:15 SW COLORADO AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1150
Practice Address - Country:US
Practice Address - Phone:541-647-0514
Practice Address - Fax:541-408-9016
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL42891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical