Provider Demographics
NPI:1710081138
Name:POWER, JILL SUSANNE (LMSW, CAADC)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SUSANNE
Last Name:POWER
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 S VAN DYKE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9800
Mailing Address - Country:US
Mailing Address - Phone:989-269-7445
Mailing Address - Fax:989-269-7490
Practice Address - Street 1:1142 S VAN DYKE RD STE 100
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9800
Practice Address - Country:US
Practice Address - Phone:989-269-7445
Practice Address - Fax:989-269-7544
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010857181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical