Provider Demographics
NPI:1578928412
Name:HANGEN, JILL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:HANGEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 45TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-2414
Mailing Address - Country:US
Mailing Address - Phone:206-498-9804
Mailing Address - Fax:206-729-6026
Practice Address - Street 1:2715 45TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-2414
Practice Address - Country:US
Practice Address - Phone:206-498-9804
Practice Address - Fax:206-729-6026
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002715103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical