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General NPI Number Information
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NPI Number | 1265632244
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Entity Type | Individual
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Provider Name | BRUCE DYKEMAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 4423 POINT FOSDICK DR NW SUITE 200
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City | GIG HARBOR
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State | WA
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Zip | 98335-1797
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Country | US
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Telephone | 262-909-0105
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1487
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City | GIG HARBOR
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State | WA
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Zip | 98335-3487
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Country | US
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Telephone | 262-909-0105
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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 | PY00002833
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1485
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 71-002164
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License Number State | IL
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