Provider Demographics
NPI:1609113232
Name:JILL R. TURCOTT-NIELSEN, LLC
Entity Type:Organization
Organization Name:JILL R. TURCOTT-NIELSEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:R
Authorized Official - Last Name:TURCOTT-NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:414-258-2600
Mailing Address - Street 1:10625 W NORTH AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2315
Mailing Address - Country:US
Mailing Address - Phone:414-258-2600
Mailing Address - Fax:262-796-8112
Practice Address - Street 1:10625 W NORTH AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2315
Practice Address - Country:US
Practice Address - Phone:414-258-2600
Practice Address - Fax:262-796-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2573-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty