Provider Demographics
NPI:1033317003
Name:SARDESON, JILL E (MFT)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:E
Last Name:SARDESON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:E
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 55457
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-0457
Mailing Address - Country:US
Mailing Address - Phone:510-324-2222
Mailing Address - Fax:
Practice Address - Street 1:225 W WINTON AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1212
Practice Address - Country:US
Practice Address - Phone:510-324-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32402106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist