Provider Demographics
NPI:1215199153
Name:KLENOTA, JILL (MFT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:KLENOTA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 VIRGINIA ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 VIRGINIA ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1439
Practice Address - Country:US
Practice Address - Phone:206-902-4271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002564101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health