Provider Demographics
NPI:1184917650
Name:KINNEY, JILL CLAIRE (PHD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:CLAIRE
Last Name:KINNEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TOWN CENTER
Mailing Address - Street 2:SUITE 180 #19
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1193
Mailing Address - Country:US
Mailing Address - Phone:206-849-3645
Mailing Address - Fax:253-517-8142
Practice Address - Street 1:20 N TACOMA AVE STE B
Practice Address - Street 2:OFFICE #3
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3133
Practice Address - Country:US
Practice Address - Phone:206-849-3645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000337103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist