Healthcare Provider Details

I. General information

NPI: 1790142610
Provider Name (Legal Business Name): JILL COREY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 01/25/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 15TH AVE E SUITE 306
SEATTLE WA
98112
US

IV. Provider business mailing address

340 15TH AVE E SUITE 306
SEATTLE WA
98112
US

V. Phone/Fax

Practice location:
  • Phone: 206-971-6708
  • Fax: 888-339-0774
Mailing address:
  • Phone: 206-971-6708
  • Fax: 888-339-0774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberNT60618568
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JILL COREY
Title or Position: OWNER
Credential: ND
Phone: 206-971-6708