Provider Demographics
NPI:1376773358
Name:VAN DINTER, JILL (LCSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:VAN DINTER
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 1:3305 BRUNSWICK DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7343
Mailing Address - Country:US
Mailing Address - Phone:719-287-8576
Mailing Address - Fax:719-634-8218
Practice Address - Street 1:616 N TEJON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1010
Practice Address - Country:US
Practice Address - Phone:719-287-8576
Practice Address - Fax:719-634-8218
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical