Provider Demographics
NPI:1780496240
Name:EILERS, JILLIAN GRACE
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:GRACE
Last Name:EILERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:IL
Mailing Address - Zip Code:61088-8349
Mailing Address - Country:US
Mailing Address - Phone:779-771-2091
Mailing Address - Fax:
Practice Address - Street 1:513 CAPITOL CT NE STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7709
Practice Address - Country:US
Practice Address - Phone:202-596-6454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC200001877101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health