Provider Demographics
NPI:1174136790
Name:PIESKE, JILL NOELLE
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:NOELLE
Last Name:PIESKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-3169
Mailing Address - Country:US
Mailing Address - Phone:507-537-6747
Mailing Address - Fax:507-537-6088
Practice Address - Street 1:3001 MAPLE RD
Practice Address - Street 2:
Practice Address - City:SLAYTON
Practice Address - State:MN
Practice Address - Zip Code:56172-4500
Practice Address - Country:US
Practice Address - Phone:507-836-6144
Practice Address - Fax:507-836-8841
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)