Provider Demographics
NPI:1396142972
Name:FIORILLO, JILLESSA (LMSW)
Entity type:Individual
Prefix:
First Name:JILLESSA
Middle Name:
Last Name:FIORILLO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JILLESSA
Other - Middle Name:
Other - Last Name:GAMMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:211 E 7TH AVE STE A220
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3090
Mailing Address - Country:US
Mailing Address - Phone:541-242-0485
Mailing Address - Fax:
Practice Address - Street 1:211 E 7TH AVE STE A220
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3090
Practice Address - Country:US
Practice Address - Phone:541-242-0485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58312104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker