Individual
MRS. JILL STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LP
Contact information
Practice address
11070 183RD CIR NW, ELK RIVER, MN 55330-2842
(763) 633-5111
(763) 633-5112
Mailing address
11070 183RD CIR NW STE C, ELK RIVER, MN 55330-3701
(763) 633-5111
(763) 633-5112
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2602
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14772000
MEDICAL ASSISTANCE
MN
Enumeration date
12/28/2006
Last updated
02/28/2023
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