Provider Demographics
NPI:1376868307
Name:ZINK, ALYCIA SHANNON (PHD)
Entity Type:Individual
Prefix:
First Name:ALYCIA
Middle Name:SHANNON
Last Name:ZINK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ALYCIA
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45-995 WAILELE RD APT 26
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3036
Mailing Address - Country:US
Mailing Address - Phone:559-288-9227
Mailing Address - Fax:
Practice Address - Street 1:9900 VETERANS DRIVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-1522
Practice Address - Country:US
Practice Address - Phone:253-583-3568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23372103G00000X, 103T00000X, 103TA0700X, 103TR0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation