Provider Demographics
NPI:1548295157
Name:MANSKE, JILL ELIZABETH (MSW)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:ELIZABETH
Last Name:MANSKE
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 1:12209 ROWAN TREE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6230
Mailing Address - Country:US
Mailing Address - Phone:703-815-7953
Mailing Address - Fax:202-273-8385
Practice Address - Street 1:OF VETERANS AFFAIRS
Practice Address - Street 2:810 VERMONT AVENUE NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20420-0001
Practice Address - Country:US
Practice Address - Phone:202-273-8549
Practice Address - Fax:202-273-8385
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN03520OtherLICENSED INDEPENDENT SW