Healthcare Provider Details

I. General information

NPI: 1962780486
Provider Name (Legal Business Name): JILL VINGE MSW, LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILL MARXER

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR # 4D-100
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1 VETERANS DR # 4D-100
MINNEAPOLIS MN
55417-2309
US

V. Phone/Fax

Practice location:
  • Phone: 651-467-3757
  • Fax:
Mailing address:
  • Phone: 651-467-3757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number450174
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9090
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17794
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: