Provider Demographics
NPI:1720077654
Name:HURST, JILL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:HURST
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 1:513 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1516
Mailing Address - Country:US
Mailing Address - Phone:574-232-2255
Mailing Address - Fax:574-246-0171
Practice Address - Street 1:513 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1516
Practice Address - Country:US
Practice Address - Phone:574-232-2255
Practice Address - Fax:574-246-0171
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical