Provider Demographics
NPI:1669549739
Name:DUNCAN, JILL K (LCSW)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:K
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51247
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-5547
Mailing Address - Country:US
Mailing Address - Phone:270-792-7058
Mailing Address - Fax:
Practice Address - Street 1:1030 SHIVE LN
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-8037
Practice Address - Country:US
Practice Address - Phone:270-792-7058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100001330Medicaid
KY0759107Medicare PIN