MEDICARE: JILL BOLTJES LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	CC01359	MN
2	101YM0800X	Mental Health Counselor	LPC-MH30892	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1255185658	OTHER	MN	COUNSELING
2	1457895864	OTHER	MN	LUVERNE COUNSELING

General Provider Information

NPI Number	:	1083155881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL BOLTJES LPCC

Provider Business Mailing Address
First Line	:	215 N CEDAR ST STE A
Second Line	:
City	:	LUVERNE
State	:	MN
Zip	:	56156-1626
Country	:	US
Telephone Number	:	507-608-5979
Fax Number	:	507-607-8774

Provider Business Practice Location Address
First Line	:	215 N CEDAR ST STE A
Second Line	:
City	:	LUVERNE
State	:	MN
Zip	:	56156-1626
Country	:	US
Telephone Number	:	507-608-5979
Fax Number	:	507-608-5979

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2017
Last Update Date	:	02/08/2026

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