Provider Demographics
NPI:1144398827
Name:TAPPER, BRUCE JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:JOHN
Last Name:TAPPER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 LANE DE CHANTEL # A
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-9671
Mailing Address - Country:US
Mailing Address - Phone:360-379-3500
Mailing Address - Fax:360-379-8866
Practice Address - Street 1:281 LANE DE CHANTEL # A
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-9671
Practice Address - Country:US
Practice Address - Phone:360-379-3500
Practice Address - Fax:360-379-8866
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY1976103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7071582Medicaid
WAAB33599Medicare ID - Type Unspecified
WA7071582Medicaid