Provider Demographics
NPI:1346579174
Name:JANNAZZO, ERIC STEPHEN (PHD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:STEPHEN
Last Name:JANNAZZO
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 1:5909 ORCHARD ST W
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98467-3824
Mailing Address - Country:US
Mailing Address - Phone:253-475-6021
Mailing Address - Fax:253-472-1296
Practice Address - Street 1:5909 ORCHARD ST W
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98467-3824
Practice Address - Country:US
Practice Address - Phone:253-475-6021
Practice Address - Fax:253-472-1296
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60107811103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist