Provider Demographics
NPI:1033516273
Name:JILLSON, DAVID WILLEM (MA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WILLEM
Last Name:JILLSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 CALIFORNIA AVE SW APT 201
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4170
Mailing Address - Country:US
Mailing Address - Phone:206-678-3882
Mailing Address - Fax:
Practice Address - Street 1:1160 140TH AVE NE STE F
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2978
Practice Address - Country:US
Practice Address - Phone:425-637-1289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60494723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health