Provider Demographics
NPI:1508334137
Name:TARDIF, ANNETTE MARIE (PHD, MA)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:MARIE
Last Name:TARDIF
Suffix:
Gender:F
Credentials:PHD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3900
Mailing Address - Country:US
Mailing Address - Phone:253-392-6748
Mailing Address - Fax:
Practice Address - Street 1:401 BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3900
Practice Address - Country:US
Practice Address - Phone:253-392-6748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60843912103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist