Individual
MRS. JILL MARIE GOLDSWORTHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
18024
MN
1041C0700X
Clinical Social Worker
2005041020
MO
1041C0700X
Clinical Social Worker
Primary
7336-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39-1850832
FEDERAL TAX ID
WI
05
—
43716200
—
WI
05
—
836118000
—
MN
Enumeration date
09/25/2006
Last updated
12/08/2021
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