Provider Demographics
NPI:1487811774
Name:ULETT, JILL A (PLCSW, MSW)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:A
Last Name:ULETT
Suffix:
Gender:F
Credentials:PLCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 BELL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1404
Mailing Address - Country:US
Mailing Address - Phone:314-249-8891
Mailing Address - Fax:
Practice Address - Street 1:4485 WESTMINSTER PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1812
Practice Address - Country:US
Practice Address - Phone:314-256-4917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080112591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical