Basic Information
| Provider Information | |||||||||
| NPI: | 1194988196 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MICHALSKI | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6533 DELFERN ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921202810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195071420 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1738 S TREMONT ST | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920545309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604392800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2008 | ||||||||
| LastUpdateDate: | 06/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 68111 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | 24300 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.