Provider Demographics
NPI:1124293683
Name:CHAFFEE, JILL (MSW)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:CHAFFEE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 STEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6917
Mailing Address - Country:US
Mailing Address - Phone:715-552-1342
Mailing Address - Fax:715-552-1644
Practice Address - Street 1:3203 STEIN BLVD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6917
Practice Address - Country:US
Practice Address - Phone:715-552-1342
Practice Address - Fax:715-552-1644
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39791900Medicaid