Provider Demographics
NPI:1598760134
Name:RATCLIFFE, ALLEN WAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:WAYNE
Last Name:RATCLIFFE
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 7558
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98417-0558
Mailing Address - Country:US
Mailing Address - Phone:253-376-4893
Mailing Address - Fax:
Practice Address - Street 1:4301 S PINE ST
Practice Address - Street 2:STE 501
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7208
Practice Address - Country:US
Practice Address - Phone:253-376-4893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA84103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4304973OtherAETNA PROVIDER NUMBER
WARA3404OtherREGENCE PROVIDER NUMBER
WAR79241Medicare UPIN