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1790181584 NPI number — JILLIAN ANNE MALINAK SUDP, CAAR

NPI Number: 1790181584
Health Care Provider/Practitioner: JILLIAN ANNE MALINAK SUDP, CAAR

Information about “1790181584” NPI (JILLIAN ANNE MALINAK SUDP, CAAR) exists in 1790181584 in HTML format HTML  |  1790181584 in plain Text format TXT  |  1790181584 in PDF (Portable Document Format) PDF  |  1790181584 in an XML format XML  formats.

NPI Number : 1790181584 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790181584",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MALINAK",
    "FirstName": "JILLIAN",
    "MiddleName": "ANNE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "SUDP, CAAR",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WHITE",
    "OtherFirstName": "JILLIAN",
    "OtherMiddleName": "ANNE",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1210 68TH AVE SE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TUMWATER",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98501-5631",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-688-7312",
    "MailingAddressFaxNumber": "360-688-7318",
    "FirstLinePracticeLocationAddress": "3773 MARTIN WAY E STE 105",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OLYMPIA",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98506",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-688-7312",
    "PracticeLocationAddressFaxNumber": "360-688-7318",
    "EnumerationDate": "11/06/2014",
    "LastUpdateDate": "03/26/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "CP60690607",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "CO6049646",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "CG60674740",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "CP60690607",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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