Provider Demographics
NPI:1992272751
Name:PIERCE, JILL COLEEN (LMSW)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:COLEEN
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 UNIVERSITY PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-5955
Mailing Address - Country:US
Mailing Address - Phone:517-336-4335
Mailing Address - Fax:517-336-0101
Practice Address - Street 1:2111 UNIVERSITY PARK DR., STE 100
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-4886
Practice Address - Country:US
Practice Address - Phone:517-336-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011000861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical