Provider Demographics
NPI:1982069035
Name:CARPENTER, JILLIAN KAY (LISW)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:KAY
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50436-2122
Mailing Address - Country:US
Mailing Address - Phone:641-355-3811
Mailing Address - Fax:
Practice Address - Street 1:103 E STATE ST STE 301
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3309
Practice Address - Country:US
Practice Address - Phone:641-421-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker