Provider Demographics
NPI:1922128446
Name:REILLY, JANE ELIZABETH (MS LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ELIZABETH
Last Name:REILLY
Suffix:
Gender:F
Credentials:MS LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 WILLOW ST STE 305
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3289
Mailing Address - Country:US
Mailing Address - Phone:612-221-0746
Mailing Address - Fax:
Practice Address - Street 1:1409 WILLOW ST STE 305
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3289
Practice Address - Country:US
Practice Address - Phone:612-221-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730726821041C0700X
MN179441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical