Provider Demographics
NPI:1598813636
Name:TIMLIN, JONELLE SULLIVAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JONELLE
Middle Name:SULLIVAN
Last Name:TIMLIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5682 N STAFFORD RD
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-0409
Mailing Address - Country:US
Mailing Address - Phone:208-664-3020
Mailing Address - Fax:208-664-3639
Practice Address - Street 1:302 N 5TH ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2814
Practice Address - Country:US
Practice Address - Phone:208-664-3020
Practice Address - Fax:208-664-3639
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-261103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist