Provider Demographics
NPI:1447801527
Name:VOLLBRECHT, JILLIAN (LICSW)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:VOLLBRECHT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW, MSW
Mailing Address - Street 1:114 9TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5857
Mailing Address - Country:US
Mailing Address - Phone:612-756-0122
Mailing Address - Fax:
Practice Address - Street 1:203 W CLARK ST
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2549
Practice Address - Country:US
Practice Address - Phone:507-377-5440
Practice Address - Fax:507-377-5498
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN232231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical