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General NPI Number Information
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NPI Number | 1205993789
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Entity Type | Individual
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Provider Name | LANE A GERBER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 901 12TH AVE SEATTLE UNIVERSITY, DEPT OF PSYCHOLOGY
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City | SEATTLE
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State | WA
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Zip | 98122-1090
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Country | US
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Telephone | 206-522-5514
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Fax |
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Provider Business Mailing Address
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Address Line | 6500 50TH AVE NE
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City | SEATTLE
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State | WA
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Zip | 98115-7737
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Country | US
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Telephone | 206-522-5514
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY00000690
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License Number State | WA
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