Provider Demographics
NPI:1215087408
Name:JEFFS-GRAD, DEBRA J (RN, MSW)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:J
Last Name:JEFFS-GRAD
Suffix:
Gender:F
Credentials:RN, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 DAYTON ST STE D
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3476
Mailing Address - Country:US
Mailing Address - Phone:425-778-8775
Mailing Address - Fax:
Practice Address - Street 1:555 DAYTON ST STE D
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3476
Practice Address - Country:US
Practice Address - Phone:425-778-8775
Practice Address - Fax:425-771-7266
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000054041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW00005404OtherCERTIFIED SOCIAL WORKER