Individual
JILL RENAE BOMSTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
5850 6TH STREET FRONTAGE RD E STE A, SPRINGFIELD, IL 62703-5194
(217) 529-5046
Mailing address
2516 W HARBAUER LN, SPRINGFIELD, IL 62702-3449
(217) 816-3048
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180011696
IL
Other
Enumeration date
01/25/2020
Last updated
10/06/2023
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