Jill Van Doornik, LLMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801098517 Issued in MI

Practice address

13101 Allen Rd
Southgate, MI 48195-2216

Phone

(734) 785-7705

Fax

(734) 287-1680

NPI assigned

Sep 3, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Guidance Center

  • Community/Behavioral Health Agency
  • Southgate, MI
  • NPI 1609947027
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442880000000",
    "number": "1023418555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13101 ALLEN RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952216",
            "telephone_number": "734-785-7705",
            "fax_number": "734-287-1680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13101 ALLEN RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952216",
            "telephone_number": "734-785-7705",
            "fax_number": "734-287-1680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DOORNIK",
        "first_name": "JILL",
        "name_prefix": "Ms.",
        "credential": "LLMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-03",
        "last_updated": "2015-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801098517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Utter, CPHT
• Nwakaego Lisa Uwaezuoke, PMHNP-BC
• Uzma Zafar MD PC
• Teresa Valla
• Amy Kathleen Van Bonn, LLMSW
• Erica Vanburen, MA
• Rachel Vanderbush, LLMSW
• Negean Vandordaklou, MD
• Marsha Vangieson
• Courtney Vanriper

• Clinical Social Worker in Southgate, MI
• Providers in Southgate, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.