Provider Demographics
NPI:1790885788
Name:KALKOFEN-JACOBSEN, JILL (CTRS)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:KALKOFEN-JACOBSEN
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 ATWELL ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-8496
Mailing Address - Country:US
Mailing Address - Phone:708-202-2250
Mailing Address - Fax:708-202-7960
Practice Address - Street 1:5TH AND ROOSEVELT
Practice Address - Street 2:BLDG. 9(11K) RECREATION
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:707-202-2250
Practice Address - Fax:707-202-7960
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist