Individual
MISS JESSICA SUE ROSE DILLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CO60579677
Contact information
Practice address
9720 S TACOMA WAY, LAKEWOOD, WA 98499-4456
(253) 503-3666
(253) 302-8493
Mailing address
3800 3RD ST SE, PUYALLUP, WA 98374-1109
(253) 200-0300
(253) 302-8493
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
80-0461504
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80-0461504
—
WA
Enumeration date
07/31/2018
Last updated
07/31/2018
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