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General NPI Number Information
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NPI Number | 1972090959
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Entity Type | Individual
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Provider Name | LADY JILL SJOSTROM
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Gender | Female
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Dates
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Enumeration Date | 04/16/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 45 NW 8TH ST STE 105
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City | HOMESTEAD
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State | FL
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Zip | 33030-4452
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Country | US
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Telephone | 754-581-6226
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Fax |
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Provider Business Mailing Address
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Address Line | 10750 NW 66TH ST APT 408
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City | DORAL
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State | FL
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Zip | 33178-3774
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Country | US
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Telephone | 786-597-2211
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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 |
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License Number State | FL
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