Provider Demographics
NPI:1528151396
Name:MUELLER, JILL SIMMONS (MSW)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SIMMONS
Last Name:MUELLER
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 1:556 GREENWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60043-1024
Mailing Address - Country:US
Mailing Address - Phone:847-256-2022
Mailing Address - Fax:
Practice Address - Street 1:1698 FIRST STREET
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3524
Practice Address - Country:US
Practice Address - Phone:847-433-8960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
4578557OtherAETNA BEHAVIORAL HEALTH
0004906737OtherBLUE CROSS BLUE SHIELD
556030Medicare ID - Type Unspecified