Provider Demographics
NPI:1093211385
Name:TRULLENDER, JONATHAN WESLEY (MSW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:WESLEY
Last Name:TRULLENDER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8270 WILLOW OAKS CORPORATE DR FL 3
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4511
Mailing Address - Country:US
Mailing Address - Phone:703-426-1064
Mailing Address - Fax:703-426-1213
Practice Address - Street 1:8270 WILLOW OAKS CORPORATE DR FL 3
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4511
Practice Address - Country:US
Practice Address - Phone:703-426-1064
Practice Address - Fax:703-426-1213
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool