Healthcare Provider Details

I. General information

NPI: 1386557023
Provider Name (Legal Business Name): JILL CARLY DEHNERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 7TH ST
SILVIS IL
61282-1142
US

IV. Provider business mailing address

251 7TH ST
SILVIS IL
61282-1142
US

V. Phone/Fax

Practice location:
  • Phone: 573-286-6737
  • Fax:
Mailing address:
  • Phone: 573-286-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.018354
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: