Healthcare Provider Details

I. General information

NPI: 1316876113
Provider Name (Legal Business Name): JILLIAN WILBUR LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S MAIN ST
WAYLAND MI
49348-1208
US

IV. Provider business mailing address

621 W MAPLE ST
WAYLAND MI
49348-1257
US

V. Phone/Fax

Practice location:
  • Phone: 269-888-4742
  • Fax:
Mailing address:
  • Phone: 616-681-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851121721
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: