Provider Demographics
NPI:1104039866
Name:HACKER, THOMAS ANTHONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:HACKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:HACKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4105 E. MADISON ST.
Mailing Address - Street 2:STE. 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3204
Mailing Address - Country:US
Mailing Address - Phone:206-322-2576
Mailing Address - Fax:
Practice Address - Street 1:4105 E. MADISON ST.
Practice Address - Street 2:STE. 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3204
Practice Address - Country:US
Practice Address - Phone:206-322-2576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001465103TC0700X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis