Provider Demographics
NPI:1861560328
Name:STIBER, JILL MICHELE (MSSW, LICSW, BCD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MICHELE
Last Name:STIBER
Suffix:
Gender:F
Credentials:MSSW, LICSW, BCD
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:MICHELE
Other - Last Name:SLAVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4006 BASSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3845
Mailing Address - Country:US
Mailing Address - Phone:952-929-1398
Mailing Address - Fax:
Practice Address - Street 1:13100 WAYZATA BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1802
Practice Address - Country:US
Practice Address - Phone:952-546-0616
Practice Address - Fax:952-573-1778
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN170961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN508R3ST 3G377LA SWOtherBLUE CROSS BLUE SHIELD
MNHP52398OtherHEALTH PARTNERS
MN876408500OtherMEDICAL ASSISTANCE
MN876408500OtherMEDICAL ASSISTANCE