Provider Demographics
NPI:1760095582
Name:JILLYN KAUFMAN, PLC
Entity Type:Organization
Organization Name:JILLYN KAUFMAN, PLC
Other - Org Name:BLUE TREE COUNSELING & CONSULTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JILLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:319-481-3534
Mailing Address - Street 1:3475 JERSEY RIDGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2293
Mailing Address - Country:US
Mailing Address - Phone:319-481-3534
Mailing Address - Fax:563-213-5615
Practice Address - Street 1:3475 JERSEY RIDGE RD STE 2
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2293
Practice Address - Country:US
Practice Address - Phone:319-481-3534
Practice Address - Fax:563-213-5615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty