Healthcare Provider Details

I. General information

NPI: 1568246270
Provider Name (Legal Business Name): MRS. JILLIAN PAIGE ZERMENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 E MAIN STE F
PUYALLUP WA
98372-3170
US

IV. Provider business mailing address

20211 111TH STREET CT E
BONNEY LAKE WA
98391-6653
US

V. Phone/Fax

Practice location:
  • Phone: 425-246-7038
  • Fax:
Mailing address:
  • Phone: 334-494-6655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCBT.CB.70162902
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: