Provider Demographics
NPI:1376082057
Name:STANTON, JILL BERNADETTE (CP 60188518)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:BERNADETTE
Last Name:STANTON
Suffix:
Gender:F
Credentials:CP 60188518
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-1527
Mailing Address - Country:US
Mailing Address - Phone:509-594-9506
Mailing Address - Fax:
Practice Address - Street 1:321 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1527
Practice Address - Country:US
Practice Address - Phone:509-865-5233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 60188518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)