Healthcare Provider Details

I. General information

NPI: 1659792109
Provider Name (Legal Business Name): JILL HULL DZIKO LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2013
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HARBOR AVE SW
SEATTLE WA
98126-2394
US

IV. Provider business mailing address

PO BOX 2191
VASHON WA
98070-2191
US

V. Phone/Fax

Practice location:
  • Phone: 206-408-7219
  • Fax:
Mailing address:
  • Phone: 206-408-7219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW 00004519
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: