Provider Demographics
NPI:1043765829
Name:HENNIG, ANNIE (MA)
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:
Last Name:HENNIG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5047 S WARNER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-4413
Mailing Address - Country:US
Mailing Address - Phone:307-421-6283
Mailing Address - Fax:
Practice Address - Street 1:4113 BRIDGEPORT WAY W STE C1
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4325
Practice Address - Country:US
Practice Address - Phone:253-993-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist