Provider Demographics
NPI:1598208027
Name:UDERMANN, JILLIAN (LMFT, MA)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:UDERMANN
Suffix:
Gender:F
Credentials:LMFT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 8TH ST NW STE A
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1780
Mailing Address - Country:US
Mailing Address - Phone:763-274-3502
Mailing Address - Fax:763-441-9057
Practice Address - Street 1:253 8TH ST NW STE A
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1780
Practice Address - Country:US
Practice Address - Phone:763-274-3502
Practice Address - Fax:763-441-9057
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3150106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist