Provider Demographics
NPI:1114241593
Name:HEATH, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:HEATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:STEVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2129 MALTBY RD
Mailing Address - Street 2:G302
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7414
Mailing Address - Country:US
Mailing Address - Phone:360-201-5923
Mailing Address - Fax:
Practice Address - Street 1:2129 MALTBY RD
Practice Address - Street 2:G302
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-7414
Practice Address - Country:US
Practice Address - Phone:360-201-5923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60148817171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator