Healthcare Provider Details

I. General information

NPI: 1487052023
Provider Name (Legal Business Name): JILL NEWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2014
Last Update Date: 12/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 MARTIN ST SUITE 2010
BLAINE WA
98230-4118
US

IV. Provider business mailing address

476 ALLAN ST
BLAINE WA
98230-9823
US

V. Phone/Fax

Practice location:
  • Phone: 360-778-1423
  • Fax:
Mailing address:
  • Phone: 206-390-2623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60220997
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: