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General NPI Number Information
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NPI Number | 1437718624
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Entity Type | Individual
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Provider Name | JILL NICOLE DELIE PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 10150 W NATIONAL AVE STE 315
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City | WEST ALLIS
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State | WI
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Zip | 53227-2145
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Country | US
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Telephone | 414-545-4430
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Fax | 414-545-4454
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Provider Business Mailing Address
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Address Line | 10150 W NATIONAL AVE SUITE 315
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City | WEST ALLIS
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State | WI
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Zip | 53227-2153
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Country | US
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Telephone | 262-668-8870
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Fax | 414-310-0560
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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 | 4160-226
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4160-226
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4043-57
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License Number State | WI
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