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General NPI Number Information
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NPI Number | 1235366675
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Entity Type | Individual
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Provider Name | JILL M PALMER MSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 2525 CHICAGO AVENUE SOUTH, 32-B852 CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-4518
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Country | US
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Telephone | 612-813-6323
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Fax | 612-813-6319
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Provider Business Mailing Address
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Address Line | 2525 CHICAGO AVENUE SOUTH, 32-B852 CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-4518
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Country | US
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Telephone | 612-813-6323
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Fax | 612-813-6319
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 12033
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12033
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License Number State | MN
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