Provider Demographics
NPI:1720579253
Name:FREDERICK, JILL (LLMSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 TOLEDO AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-1624
Mailing Address - Country:US
Mailing Address - Phone:734-777-3177
Mailing Address - Fax:
Practice Address - Street 1:622 TOLEDO AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1624
Practice Address - Country:US
Practice Address - Phone:734-777-3177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851102380104100000X
MI6801102380104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker