Provider Demographics
NPI:1346950615
Name:JILL CORDER LLC
Entity Type:Organization
Organization Name:JILL CORDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:CORDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:618-973-7139
Mailing Address - Street 1:189 E US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-2266
Mailing Address - Country:US
Mailing Address - Phone:618-973-7139
Mailing Address - Fax:618-505-5044
Practice Address - Street 1:189 E US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-2266
Practice Address - Country:US
Practice Address - Phone:618-973-7139
Practice Address - Fax:618-505-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health