Healthcare Provider Details

I. General information

NPI: 1396986402
Provider Name (Legal Business Name): RYAN W COON PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5909 ORCHARD ST W
TACOMA WA
98467-3824
US

IV. Provider business mailing address

5909 ORCHARD ST W
TACOMA WA
98467-3824
US

V. Phone/Fax

Practice location:
  • Phone: 253-475-6021
  • Fax: 253-472-1296
Mailing address:
  • Phone: 253-475-6021
  • Fax: 253-472-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY00003771
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number00003771
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: