Provider Demographics
NPI:1861600736
Name:FLOWER, JILL T (PHD LP)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:T
Last Name:FLOWER
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 UNIVERSTIY AVE W
Mailing Address - Street 2:SUITE 325
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3458
Mailing Address - Country:US
Mailing Address - Phone:651-644-4069
Mailing Address - Fax:
Practice Address - Street 1:1885 UNIVERSTIY AVE W
Practice Address - Street 2:SUITE 325
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3458
Practice Address - Country:US
Practice Address - Phone:651-644-4069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2513103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8L44FLOtherBCBS
MN916753600Medicaid
MN916753600Medicaid