Healthcare Provider Details

I. General information

NPI: 1467309443
Provider Name (Legal Business Name): JILL DUFNER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 TEXAS AVE S
ST LOUIS PARK MN
55426-2518
US

IV. Provider business mailing address

4902 ARLINGTON DR
MINNETONKA MN
55343-8763
US

V. Phone/Fax

Practice location:
  • Phone: 952-928-6389
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number30027
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: