Provider Demographics
NPI:1447552278
Name:WILLETT-SEWALL, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:WILLETT-SEWALL
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 1:408 POND RD
Mailing Address - Street 2:
Mailing Address - City:DYER BROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04747-5128
Mailing Address - Country:US
Mailing Address - Phone:207-757-7017
Mailing Address - Fax:
Practice Address - Street 1:408 POND RD
Practice Address - Street 2:
Practice Address - City:DYER BROOK
Practice Address - State:ME
Practice Address - Zip Code:04747-5128
Practice Address - Country:US
Practice Address - Phone:207-757-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2221101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional