Provider Demographics
NPI:1871042184
Name:ESTRADA, JILL SUZANNE GERMAIN (M ED)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SUZANNE GERMAIN
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:SUZANNE
Other - Last Name:GERMAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 TIMBER HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:PORT LUDLOW
Mailing Address - State:WA
Mailing Address - Zip Code:98365-8247
Mailing Address - Country:US
Mailing Address - Phone:360-215-0511
Mailing Address - Fax:
Practice Address - Street 1:651 STRANDER BLVD STE 105
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2914
Practice Address - Country:US
Practice Address - Phone:206-313-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA60905343103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst