Provider Demographics
NPI:1952478562
Name:MCCUTCHEON, JILL (LSCW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MCCUTCHEON
Suffix:
Gender:F
Credentials:LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6978
Mailing Address - Country:US
Mailing Address - Phone:815-575-6224
Mailing Address - Fax:
Practice Address - Street 1:457 COVENTRY LN
Practice Address - Street 2:SUITE 129A
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7571
Practice Address - Country:US
Practice Address - Phone:815-575-6224
Practice Address - Fax:815-575-6224
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490115691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical