| Doctor Name: | JILL DIANE ELLINWOOD |
| NPI Number: | 1275666935 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LCSW, LPC |
| License Number: | 647-125 |
| Business Practice Address: | 505 Broadway St Baraboo, WI - 539132183 |
| Business Phone Number: | 6083554214 |
| Business Fax Number: | |
| Mailing Address: | S5789 S Shore Rd, BARABOO |
| State: | WI |
| Postal Code: | 539139235 |
| Phone Number: | 6083567039 |
| Fax Number: | |
| NPI Enumeration Date: | 03/13/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 647-125 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |