Provider Demographics
NPI:1720121973
Name:HARTWIG, JILL SUZANNE (BA CADC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:SUZANNE
Last Name:HARTWIG
Suffix:
Gender:F
Credentials:BA CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5035 LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-5840
Mailing Address - Country:US
Mailing Address - Phone:815-560-2399
Mailing Address - Fax:
Practice Address - Street 1:2704 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103
Practice Address - Country:US
Practice Address - Phone:815-968-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)