Jill Lynnette Patrick, AAS, CDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP00004308 Issued in WA

Practice address

500 SE Washington Ave
Chehalis, WA 98532-3058

Phone

(360) 740-2539

NPI assigned

Oct 17, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Associate of Applied Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539734400000",
    "number": "1902372915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SE WASHINGTON AVE",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985323058",
            "telephone_number": "360-740-2539",
            "fax_number": "360-740-2551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SE WASHINGTON AVE",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985323058",
            "telephone_number": "360-740-2539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATRICK",
        "first_name": "JILL",
        "middle_name": "LYNNETTE",
        "credential": "AAS, CDP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-17",
        "last_updated": "2018-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP00004308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyas Eileen Pannette, TN
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• Stacy E Park, LMT
• Sarah E. Parker, LMP
• Marla Elaine Parramore, LICSW, MSSW, CDP
• Dorinda L Paul, CNA
• Frank R Paulin, RN
• Beatrice K Paynter
• David Scott Pazoff
• Andrea Peak, CDPT

• Addiction (Substance Use Disorder) Counselor in Chehalis, WA
• Providers in Chehalis, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.