Provider Demographics
NPI:1124191101
Name:QUILLMAN, RALPH KIEFFER (ACSW)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:KIEFFER
Last Name:QUILLMAN
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 105TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208
Mailing Address - Country:US
Mailing Address - Phone:425-385-8118
Mailing Address - Fax:425-385-3748
Practice Address - Street 1:1814 105TH ST SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:425-385-8118
Practice Address - Fax:425-385-3748
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000065311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical