Provider Demographics
NPI:1699946699
Name:KENT, JILL BULLOCK (MSW)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:BULLOCK
Last Name:KENT
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 1:4014 160TH STREET
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323
Mailing Address - Country:US
Mailing Address - Phone:515-491-6538
Mailing Address - Fax:
Practice Address - Street 1:4014 160TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50323-2268
Practice Address - Country:US
Practice Address - Phone:515-491-6538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA12761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical