Provider Demographics
NPI:1669825618
Name:FRITTS, JILL ANN
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANN
Last Name:FRITTS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:ANN
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4031 WEST DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050
Mailing Address - Country:US
Mailing Address - Phone:815-759-7107
Mailing Address - Fax:815-759-7115
Practice Address - Street 1:4031 W DAYTON ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8377
Practice Address - Country:US
Practice Address - Phone:815-759-7107
Practice Address - Fax:815-759-7115
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker