Provider Demographics
NPI:1710419247
Name:LILA, JENNIFER N (LCSW, CSAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:LILA
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W245N6630 BOWLING GREEN ST
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-2638
Mailing Address - Country:US
Mailing Address - Phone:262-501-6533
Mailing Address - Fax:
Practice Address - Street 1:N64W24050 MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3000
Practice Address - Country:US
Practice Address - Phone:262-501-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16400-132101YA0400X
WI9100-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)