Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2469 | WA |
Y | 103T00000X | Psychologist | 2469 | WA |
NPI | 1003039025 |
---|---|
Provider Name | Dr. William H. Jackline |
First Address | Spokane, WA 99224-8256 |
Second Address | Spokane, WA 99202-2220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |