Provider Demographics
NPI:1508196353
Name:SCHILDBACH, JONATHAN CHRISTIAN (MA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CHRISTIAN
Last Name:SCHILDBACH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 LOMBARD AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3619
Mailing Address - Country:US
Mailing Address - Phone:425-212-3993
Mailing Address - Fax:425-259-3073
Practice Address - Street 1:2801 LOMBARD AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3619
Practice Address - Country:US
Practice Address - Phone:425-212-3993
Practice Address - Fax:425-259-3073
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC60024918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health