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General NPI Number Information
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NPI Number | 1841164209
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Entity Type | Individual
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Provider Name | JILL KOERSELMAN SURESH MSW, LSWAIC
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Gender | Female
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Dates
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Enumeration Date | 09/30/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 4015 NE 6TH CT
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City | RENTON
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State | WA
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Zip | 98056-3972
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Country | US
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Telephone | 509-761-9526
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Fax |
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Provider Business Mailing Address
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Address Line | 4004 NE 4TH ST STE 107
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City | RENTON
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State | WA
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Zip | 98056-4102
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Country | US
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Telephone | 509-761-9526
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SWIA.SC.61647452
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License Number State | WA
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