Provider Demographics
NPI:1790833010
Name:DON, AUDREY JEAN (PHD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:JEAN
Last Name:DON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1025
Mailing Address - Country:US
Mailing Address - Phone:253-284-0906
Mailing Address - Fax:253-573-0211
Practice Address - Street 1:1916 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1025
Practice Address - Country:US
Practice Address - Phone:253-284-0906
Practice Address - Fax:253-573-0211
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002420103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist