Provider Demographics
NPI:1073343844
Name:JENNIFER LILA
Entity type:Organization
Organization Name:JENNIFER LILA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:N
Authorized Official - Last Name:LILA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CSAC
Authorized Official - Phone:262-501-6533
Mailing Address - Street 1:W245N6630 BOWLING GREEN ST
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-2638
Mailing Address - Country:US
Mailing Address - Phone:262-501-6533
Mailing Address - Fax:
Practice Address - Street 1:N64W24050 MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3000
Practice Address - Country:US
Practice Address - Phone:262-501-6533
Practice Address - Fax:262-462-0451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty