Provider Demographics
NPI:1487052023
Name:NEWMAN, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:NEWMAN
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 1:476 ALLAN ST
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9823
Mailing Address - Country:US
Mailing Address - Phone:206-390-2623
Mailing Address - Fax:
Practice Address - Street 1:435 MARTIN ST
Practice Address - Street 2:SUITE 2010
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-4118
Practice Address - Country:US
Practice Address - Phone:360-778-1423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-14
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW602209971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical