Individual
JENNIFER A TILLISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
4227 9TH AVE SW, FARGO, ND 58103-2018
(701) 478-9535
(701) 365-0021
Mailing address
4227 9TH AVE SW, FARGO, ND 58103-2018
(701) 478-9535
(701) 365-0021
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1688
ND
Other
Enumeration date
01/24/2013
Last updated
01/24/2013
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