Provider Demographics
NPI:1396920013
Name:ROSENTHAL, JILL ELAINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:ELAINE
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20006 CEDAR VALLEY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6334
Mailing Address - Country:US
Mailing Address - Phone:206-605-5903
Mailing Address - Fax:360-805-1304
Practice Address - Street 1:20006 CEDAR VALLEY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6334
Practice Address - Country:US
Practice Address - Phone:206-605-5903
Practice Address - Fax:360-805-1304
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003890103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical