Provider Demographics
NPI:1720163389
Name:WEYERHAEUSER, GAIL TOYCEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:TOYCEN
Last Name:WEYERHAEUSER
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 1:1250 PACIFIC AVE
Mailing Address - Street 2:STE #875
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402
Mailing Address - Country:US
Mailing Address - Phone:253-572-2745
Mailing Address - Fax:253-572-2947
Practice Address - Street 1:1250 PACIFIC AVE
Practice Address - Street 2:STE #875
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402
Practice Address - Country:US
Practice Address - Phone:253-572-2745
Practice Address - Fax:253-572-2947
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2449103TC0700X
WAPY00002449103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA524703OtherVALUE OPTIONS
WA8201WEOtherREGENCE
WAG8858015OtherMEDICARE GRP PIN
WA7147234Medicare PIN
WA524703OtherVALUE OPTIONS
WA602-531-776Medicare UPIN
WAG8858016Medicare PIN