Provider Demographics
NPI:1922156645
Name:TANNER, PENNY LEAH (PHD, ARNP)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:LEAH
Last Name:TANNER
Suffix:
Gender:F
Credentials:PHD, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7424 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8120
Mailing Address - Country:US
Mailing Address - Phone:253-581-6106
Mailing Address - Fax:253-581-6275
Practice Address - Street 1:7424 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 302
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8120
Practice Address - Country:US
Practice Address - Phone:253-581-6106
Practice Address - Fax:253-581-6275
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health