Doctor Name: | DR. JEFFREY BRUCE GILLMAN |
NPI Number: | 1184778813 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | PY00002232 |
Business Practice Address: | 18500 156th Ave Ne Suite #202 Woodinville, WA - 980724459 |
Business Phone Number: | 4255918889 |
Business Fax Number: | 4254812157 |
Mailing Address: | 18500 156th Ave Ne, Suite #202 WOODINVILLE |
State: | WA |
Postal Code: | 980724459 |
Phone Number: | 4255918889 |
Fax Number: | 4254812157 |
NPI Enumeration Date: | 01/22/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PY00002232 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |