Healthcare Provider Details

I. General information

NPI: 1063002921
Provider Name (Legal Business Name): ADRIENNE IONE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2021
Last Update Date: 01/24/2021
Certification Date: 01/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 S G ST
TACOMA WA
98405-4733
US

IV. Provider business mailing address

316 S G ST
TACOMA WA
98405-4733
US

V. Phone/Fax

Practice location:
  • Phone: 253-988-6463
  • Fax:
Mailing address:
  • Phone: 253-988-6463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: