Provider Demographics
NPI:1265632244
Name:DYKEMAN, BRUCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:DYKEMAN
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:PO BOX 1487
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-3487
Mailing Address - Country:US
Mailing Address - Phone:262-909-0105
Mailing Address - Fax:
Practice Address - Street 1:4423 POINT FOSDICK DR NW
Practice Address - Street 2:SUITE 200
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1797
Practice Address - Country:US
Practice Address - Phone:262-909-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002833103TC0700X
WI1485103TC0700X
IL71-002164103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1485OtherWISCONSIN PSYCHOLOGIST
IL71-002164OtherILLINOIS PSYCHOLOGIST
WAPY00002833OtherWASHINGTON PSYCHOLOGIST