Healthcare Provider Details

I. General information

NPI: 1376868307
Provider Name (Legal Business Name): ALYCIA SHANNON ZINK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYCIA WHITE

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 VETERANS DRIVE
TACOMA WA
98493-1522
US

IV. Provider business mailing address

45-995 WAILELE RD APT 26
KANEOHE HI
96744-3036
US

V. Phone/Fax

Practice location:
  • Phone: 253-583-3568
  • Fax:
Mailing address:
  • Phone: 559-288-9227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY23372
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY23372
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY23372
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSY23372
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY23372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: