Provider Demographics
NPI:1457026338
Name:REGISTER, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:REGISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 39TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3916
Mailing Address - Country:US
Mailing Address - Phone:515-979-0924
Mailing Address - Fax:844-754-3428
Practice Address - Street 1:3806 EASTON BLVD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317-5730
Practice Address - Country:US
Practice Address - Phone:515-661-5894
Practice Address - Fax:844-754-3428
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22026101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)