Provider Demographics
NPI:1003435694
Name:KILMER, JARED NEWMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:NEWMAN
Last Name:KILMER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12025 115TH AVE NE
Mailing Address - Street 2:BUILDING D STE 215
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7304
Mailing Address - Country:US
Mailing Address - Phone:425-222-2599
Mailing Address - Fax:
Practice Address - Street 1:12025 115TH AVE NE STE 215
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6943
Practice Address - Country:US
Practice Address - Phone:425-405-5316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60963309103TC0700X
TX37976103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical