Provider Demographics
NPI:1841487444
Name:JILL L. KOFENDER, PHD, PLLC
Entity type:Organization
Organization Name:JILL L. KOFENDER, PHD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOFENDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-867-8766
Mailing Address - Street 1:5640 WEST MAPLE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3718
Mailing Address - Country:US
Mailing Address - Phone:248-867-8766
Mailing Address - Fax:248-669-1925
Practice Address - Street 1:5640 WEST MAPLE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3718
Practice Address - Country:US
Practice Address - Phone:248-867-8766
Practice Address - Fax:248-669-1925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012830103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty