Healthcare Provider Details

I. General information

NPI: 1083155881
Provider Name (Legal Business Name): JILL BOLTJES LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N CEDAR ST STE A
LUVERNE MN
56156-1626
US

IV. Provider business mailing address

215 N CEDAR ST STE A
LUVERNE MN
56156-1626
US

V. Phone/Fax

Practice location:
  • Phone: 507-608-5979
  • Fax: 507-608-5979
Mailing address:
  • Phone: 507-608-5979
  • Fax: 507-607-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-MH30892
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC01359
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: