Provider Demographics
NPI:1659792109
Name:HULL DZIKO, JILL (LICSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:HULL DZIKO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2191
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-2191
Mailing Address - Country:US
Mailing Address - Phone:206-408-7219
Mailing Address - Fax:
Practice Address - Street 1:3400 HARBOR AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2394
Practice Address - Country:US
Practice Address - Phone:206-408-7219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 000045191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical