Provider Demographics
NPI:1578802963
Name:O'TOOLE, JILL ANN (LSW)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANN
Last Name:O'TOOLE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 N CLAUDE A LORD BLVD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2706
Mailing Address - Country:US
Mailing Address - Phone:570-622-1025
Mailing Address - Fax:570-628-4344
Practice Address - Street 1:454 N CLAUDE A LORD BLVD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2706
Practice Address - Country:US
Practice Address - Phone:570-622-1025
Practice Address - Fax:570-628-4344
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW127739104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker