Provider Demographics
NPI:1720283120
Name:KARLSSON, JILL M (PSYD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:KARLSSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:WERNER KARLSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSE
Mailing Address - Street 1:10045 N STATE ROAD 27
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-3525
Mailing Address - Country:US
Mailing Address - Phone:715-634-0222
Mailing Address - Fax:715-634-1722
Practice Address - Street 1:10045 N STATE ROAD 27
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-3525
Practice Address - Country:US
Practice Address - Phone:715-634-0222
Practice Address - Fax:715-634-1722
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2540-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43575400Medicaid