Provider Demographics
NPI:1598952301
Name:SIMON, JILL EVELYN (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:EVELYN
Last Name:SIMON
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 ASBURY STREET
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1851
Mailing Address - Country:US
Mailing Address - Phone:651-646-7010
Mailing Address - Fax:651-646-7668
Practice Address - Street 1:570 ASBURY STREET
Practice Address - Street 2:SUITE 310
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1851
Practice Address - Country:US
Practice Address - Phone:651-646-7010
Practice Address - Fax:651-646-7668
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN144571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical