Provider Demographics
NPI:1366169906
Name:WILLOUGHBY, JILLIAN ANN
Entity type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:ANN
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:ANN
Other - Last Name:HOVINGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1449 URLAGE DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-6507
Mailing Address - Country:US
Mailing Address - Phone:513-608-8023
Mailing Address - Fax:
Practice Address - Street 1:1449 URLAGE DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-6507
Practice Address - Country:US
Practice Address - Phone:513-608-8023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker