Healthcare Provider Details

I. General information

NPI: 1346436466
Provider Name (Legal Business Name): JILL ELIZABETH HEWITT M.S., L.M.F.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL ELIZABETH STOLL LMFT

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 SIBLEY AVE
GAYLORD MN
55334-2386
US

IV. Provider business mailing address

716 SIBLEY AVE
GAYLORD MN
55334-2386
US

V. Phone/Fax

Practice location:
  • Phone: 507-237-9987
  • Fax: 507-237-2027
Mailing address:
  • Phone: 507-237-9987
  • Fax: 507-237-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1102
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: