Provider Demographics
NPI:1902032725
Name:NEALEY-MOORE, JILL B (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:B
Last Name:NEALEY-MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:B
Other - Last Name:NEALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:621 PACIFIC AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4600
Mailing Address - Country:US
Mailing Address - Phone:253-444-3557
Mailing Address - Fax:
Practice Address - Street 1:621 PACIFIC AVE
Practice Address - Street 2:STE 310
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4600
Practice Address - Country:US
Practice Address - Phone:253-444-3557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003515103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth