Provider Demographics
NPI:1366844227
Name:PAGE, JILL BALLARD (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:BALLARD
Last Name:PAGE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 HANDEL CT
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-2055
Mailing Address - Country:US
Mailing Address - Phone:630-212-9661
Mailing Address - Fax:
Practice Address - Street 1:10402 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4704
Practice Address - Country:US
Practice Address - Phone:708-422-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.013468104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker