Provider Demographics
NPI:1184778813
Name:GILLMAN, JEFFREY BRUCE (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRUCE
Last Name:GILLMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18500 156TH AVE NE
Mailing Address - Street 2:SUITE #202
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-4459
Mailing Address - Country:US
Mailing Address - Phone:425-591-8889
Mailing Address - Fax:425-481-2157
Practice Address - Street 1:18500 156TH AVE NE
Practice Address - Street 2:SUITE #202
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-4459
Practice Address - Country:US
Practice Address - Phone:425-591-8889
Practice Address - Fax:425-481-2157
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002232103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical