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General NPI Number Information
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NPI Number | 1760440895
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Entity Type | Individual
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Provider Name | JOSEPH R ETHERAGE PSYD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | BLDG 9040 FITZSIMMONS DRIVE
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-2751
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Fax |
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Provider Business Mailing Address
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Address Line | 3047 OLD PORT LN NW
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City | OLYMPIA
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State | WA
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Zip | 98502-3963
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Country | US
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Telephone | 360-481-7081
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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 | 981
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License Number State | AL
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