Provider Demographics
NPI:1962780486
Name:VINGE, JILL (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:VINGE
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:MARXER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 VETERANS DR # 4D-100
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:651-467-3757
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR # 4D-100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:651-467-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17794104100000X
WI9090104100000X
MN4501741041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool