Provider Demographics
NPI:1548539505
Name:GERNERT, JILL ANN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANN
Last Name:GERNERT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 SOMERVILLE RD SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4305
Mailing Address - Country:US
Mailing Address - Phone:256-260-7361
Mailing Address - Fax:256-341-0747
Practice Address - Street 1:4110 US HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1644
Practice Address - Country:US
Practice Address - Phone:256-260-7361
Practice Address - Fax:256-355-6092
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010924001041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical