Healthcare Provider Details

I. General information

NPI: 1558922708
Provider Name (Legal Business Name): JILL A WALKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SCHOOL ST
ELLSWORTH ME
04605-1932
US

IV. Provider business mailing address

PO BOX 316
MOUNT DESERT ME
04660-0316
US

V. Phone/Fax

Practice location:
  • Phone: 207-479-4615
  • Fax: 207-223-7885
Mailing address:
  • Phone: 207-479-4615
  • Fax: 207-223-7885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC20443
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: