Provider Demographics
NPI:1538724885
Name:JILLSON, SUSAN ANGLIKER
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANGLIKER
Last Name:JILLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SPINDLEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-8206
Mailing Address - Country:US
Mailing Address - Phone:203-444-3947
Mailing Address - Fax:
Practice Address - Street 1:305 SPINDLEWOOD WAY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-8206
Practice Address - Country:US
Practice Address - Phone:203-444-3947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC129951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical