Provider Demographics
NPI:1902017262
Name:LEVIN, JILL MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:LEVIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9564 131ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-4721
Mailing Address - Country:US
Mailing Address - Phone:763-633-5111
Mailing Address - Fax:763-633-5112
Practice Address - Street 1:11070 183RD CIR NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2842
Practice Address - Country:US
Practice Address - Phone:763-633-5111
Practice Address - Fax:763-633-5112
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN139321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical