Provider Demographics
NPI:1205083938
Name:FANCHER, JILL (PHD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:FANCHER
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 1:2621 NE 134TH ST
Mailing Address - Street 2:STE 340
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-3036
Mailing Address - Country:US
Mailing Address - Phone:360-450-0140
Mailing Address - Fax:877-343-0535
Practice Address - Street 1:2621 NE 134TH ST
Practice Address - Street 2:STE 340
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3036
Practice Address - Country:US
Practice Address - Phone:360-450-0140
Practice Address - Fax:877-343-0535
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60103625103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth