Provider Demographics
NPI:1518550185
Name:ALEXANDER-TRAVERS, JILLIAN JEAN
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:JEAN
Last Name:ALEXANDER-TRAVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E SPOKANE FALLS BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1612
Mailing Address - Country:US
Mailing Address - Phone:509-855-9373
Mailing Address - Fax:
Practice Address - Street 1:202 E SPOKANE FALLS BLVD STE 302
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1612
Practice Address - Country:US
Practice Address - Phone:509-855-9373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WASC61320020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program