Provider Demographics
NPI:1841359825
Name:DOBSON, JILL LESLIE (RD, CD)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:LESLIE
Last Name:DOBSON
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 NW 191ST ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2811
Mailing Address - Country:US
Mailing Address - Phone:206-354-3395
Mailing Address - Fax:
Practice Address - Street 1:2915 E MADISON ST STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4246
Practice Address - Country:US
Practice Address - Phone:206-354-3395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA852701133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered