Provider Demographics
NPI:1992858997
Name:GRACE HERSCH, JILL A (LCSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:GRACE HERSCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:A
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:499 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1546
Mailing Address - Country:US
Mailing Address - Phone:541-488-0883
Mailing Address - Fax:541-488-0893
Practice Address - Street 1:499 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1546
Practice Address - Country:US
Practice Address - Phone:541-488-0883
Practice Address - Fax:541-488-0893
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL32351041C0700X
CALCS198121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR116891Medicare PIN