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General NPI Number Information
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NPI Number | 1275666935
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Entity Type | Individual
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Provider Name | JILL DIANE ELLINWOOD MA, LCSW, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 505 BROADWAY ST
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City | BARABOO
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State | WI
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Zip | 53913-2183
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Country | US
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Telephone | 608-355-4214
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Fax |
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Provider Business Mailing Address
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Address Line | S5789 S SHORE RD
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City | BARABOO
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State | WI
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Zip | 53913-9235
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Country | US
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Telephone | 608-356-7039
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 647-125
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License Number State | WI
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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 | 1197-123
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License Number State | WI
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