Provider Demographics
NPI:1790181584
Name:MALINAK, JILLIAN ANNE (SUDP, CAAR)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:ANNE
Last Name:MALINAK
Suffix:
Gender:F
Credentials:SUDP, CAAR
Other - Prefix:MISS
Other - First Name:JILLIAN
Other - Middle Name:ANNE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1210 68TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5631
Mailing Address - Country:US
Mailing Address - Phone:360-688-7312
Mailing Address - Fax:360-688-7318
Practice Address - Street 1:3773 MARTIN WAY E STE 105
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-688-7312
Practice Address - Fax:360-688-7318
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60690607101YA0400X, 101Y00000X
WACO6049646101YA0400X
WACG60674740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health