Provider Demographics
NPI:1942003249
Name:SMITH, JILLIAN ELIZABETH (MSW)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 LILAC RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-9542
Mailing Address - Country:US
Mailing Address - Phone:574-952-5359
Mailing Address - Fax:
Practice Address - Street 1:3201 E CENTER STREET EXT
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582-3907
Practice Address - Country:US
Practice Address - Phone:574-267-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker