Provider Demographics
NPI:1396878831
Name:SYERS, MARYANN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:
Last Name:SYERS
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 1:109 NORTH BEACH RD. - 284
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-1935
Mailing Address - Country:US
Mailing Address - Phone:360-376-6100
Mailing Address - Fax:
Practice Address - Street 1:109 NORTH BEACH RD. - 284
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-1935
Practice Address - Country:US
Practice Address - Phone:360-376-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW603245661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN114757900Medicaid
MN800000367Medicare UPIN