Provider Demographics
NPI:1245344969
Name:KELPIN, JILL DIANE (LICSW)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:DIANE
Last Name:KELPIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 S STATE STREET
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073
Mailing Address - Country:US
Mailing Address - Phone:507-354-3181
Mailing Address - Fax:507-354-3183
Practice Address - Street 1:1407 S STATE STREET
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073
Practice Address - Country:US
Practice Address - Phone:507-354-3181
Practice Address - Fax:507-354-3183
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN148761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1026046OtherPREFERRED ONE
32G97KEOtherBCBS
141950OtherUCARE