Provider Demographics
NPI:1205993789
Name:GERBER, LANE A (PHD)
Entity type:Individual
Prefix:
First Name:LANE
Middle Name:A
Last Name:GERBER
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 1:6500 50TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7737
Mailing Address - Country:US
Mailing Address - Phone:206-522-5514
Mailing Address - Fax:
Practice Address - Street 1:901 12TH AVE
Practice Address - Street 2:SEATTLE UNIVERSITY, DEPT OF PSYCHOLOGY
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-1090
Practice Address - Country:US
Practice Address - Phone:206-522-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000690103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical