Provider Demographics
NPI:1841532215
Name:SKY-TUCKER, JILLIAN (MA)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:SKY-TUCKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 DELRIDGE WAY SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1379
Mailing Address - Country:US
Mailing Address - Phone:206-937-7680
Mailing Address - Fax:
Practice Address - Street 1:4555 DELRIDGE WAY SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-1379
Practice Address - Country:US
Practice Address - Phone:206-937-7680
Practice Address - Fax:206-935-9967
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60307761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health