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NPI Code Detail

MEDICARE: JILL CARLSON

MEDICARE: JILL CARLSON
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
1101YM0800XMental Health Counselor586MN

General Provider Information

NPI Number : 1831509850
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL CARLSON
Provider Business Mailing Address
First Line : 14300 NICOLLET CT STE 130
Second Line :
City : BURNSVILLE
State : MN
Zip : 55306-3422
Country : US
Telephone Number : 651-286-8527
Fax Number : 651-647-1861
Provider Business Practice Location Address
First Line : 14300 NICOLLET CT STE 130
Second Line :
City : BURNSVILLE
State : MN
Zip : 55306-3422
Country : US
Telephone Number : 651-286-8527
Fax Number : 651-647-1861
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2014
Last Update Date : 04/29/2014

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Directions to “ JILL CARLSON ” Practice Location

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