Provider Demographics
NPI:1528225158
Name:KAUFMAN, JILLYN M (LISW)
Entity Type:Individual
Prefix:
First Name:JILLYN
Middle Name:M
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:JILLYN
Other - Middle Name:
Other - Last Name:KYARSGAARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:3475 JERSEY RIDGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2293
Mailing Address - Country:US
Mailing Address - Phone:319-481-3534
Mailing Address - Fax:563-213-5615
Practice Address - Street 1:3475 JERSEY RIDGE RD STE 2
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2293
Practice Address - Country:US
Practice Address - Phone:319-481-3534
Practice Address - Fax:563-213-5615
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0146771041C0700X
IA0078611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07861OtherBOARD OF SOCIAL WORK