Basic Information
| Provider Information | |||||||||
| NPI: | 1831633056 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGILL | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | JOY ELIZABETH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CMA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VODA | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | JOY ELIZABETH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | CMA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 27715 NE 146TH WAY | ||||||||
| Address2: | |||||||||
| City: | DUVALL | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980196336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143299902 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4526 FEDERAL AVE BLDG 1 | ||||||||
| Address2: | MAILSTOP 11 | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982032132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253498359 | ||||||||
| FaxNumber: | 4253498348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2016 | ||||||||
| LastUpdateDate: | 12/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CM60373262 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.