Basic Information
| Provider Information | |||||||||
| NPI: | 1073168076 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SILVA | ||||||||
| FirstName: | JESUS | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LICSWA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3216 92ND PL SE | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982083001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064846300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3330 MONTE VILLA PKWY | ||||||||
| Address2: | |||||||||
| City: | BOTHELL | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980218972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254086000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2019 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SC60720479 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.