Provider Demographics
NPI:1528457082
Name:GILLUM, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GILLUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4746 11TH AVE NE
Mailing Address - Street 2:APT. 206
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4657
Mailing Address - Country:US
Mailing Address - Phone:509-435-1840
Mailing Address - Fax:
Practice Address - Street 1:4746 11TH AVE NE
Practice Address - Street 2:APT. 206
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4657
Practice Address - Country:US
Practice Address - Phone:509-435-1840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst