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General NPI Number Information
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NPI Number | 1790181584
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Entity Type | Individual
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Provider Name | JILLIAN ANNE MALINAK SUDP, CAAR
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Gender | Female
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Dates
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Enumeration Date | 11/06/2014
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 3773 MARTIN WAY E STE 105
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City | OLYMPIA
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State | WA
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Zip | 98506
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Country | US
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Telephone | 360-688-7312
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Fax | 360-688-7318
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Provider Business Mailing Address
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Address Line | 1210 68TH AVE SE
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City | TUMWATER
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State | WA
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Zip | 98501-5631
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Country | US
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Telephone | 360-688-7312
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Fax | 360-688-7318
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP60690607
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CO6049646
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CG60674740
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CP60690607
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License Number State | WA
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