Provider Demographics
NPI:1497943377
Name:GAIL T. WEYERHAEUSER, PHD PLLC
Entity Type:Organization
Organization Name:GAIL T. WEYERHAEUSER, PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:TOYCEN
Authorized Official - Last Name:WEYERHAEUSER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:253-572-2745
Mailing Address - Street 1:1250 PACIFIC AVE
Mailing Address - Street 2:SUITE 875
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4318
Mailing Address - Country:US
Mailing Address - Phone:253-572-2745
Mailing Address - Fax:253-572-2947
Practice Address - Street 1:1250 PACIFIC AVE
Practice Address - Street 2:SUITE 875
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4318
Practice Address - Country:US
Practice Address - Phone:253-572-2745
Practice Address - Fax:253-572-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2449103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8858015Medicare PIN