Healthcare Provider Details

I. General information

NPI: 1669387072
Provider Name (Legal Business Name): JILLIAN MADELEINE CONKLIN LSW, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 W GRAISBURY AVE
AUDUBON NJ
08106-2015
US

IV. Provider business mailing address

605 W GRAISBURY AVE
AUDUBON NJ
08106-2015
US

V. Phone/Fax

Practice location:
  • Phone: 856-366-0337
  • Fax:
Mailing address:
  • Phone: 856-366-0337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07516000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00417800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: