Provider Demographics
NPI:1760670053
Name:ISENBERG, JILL C (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:C
Last Name:ISENBERG
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Gender:F
Credentials:PHD, LP
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Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:SUITE 3S32
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-6069
Mailing Address - Fax:314-454-4013
Practice Address - Street 1:1502 LONDON RD STE 102
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1787
Practice Address - Country:US
Practice Address - Phone:218-576-0187
Practice Address - Fax:218-576-0126
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
MNLP5905103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist