Provider Demographics
NPI:1669814752
Name:FERRIS, JILL (LMP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:FERRIS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6628 LY RHON CT SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7903
Mailing Address - Country:US
Mailing Address - Phone:360-951-2626
Mailing Address - Fax:
Practice Address - Street 1:509 12TH AVE SE STE 10
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-7500
Practice Address - Country:US
Practice Address - Phone:360-951-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60393448172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker