Individual
JILL MARIE GROTLUSCHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.S.W
Contact information
Practice address
1112 NODAK DR S, SUITE 200, FARGO, ND 58103-2366
(701) 280-9545
(701) 280-9520
Mailing address
1112 NODAK DR S, SUITE 200, FARGO, ND 58103-2366
(701) 280-9545
(701) 280-9520
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
4388
ND
Other
Enumeration date
05/07/2012
Last updated
05/07/2012
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