Provider Demographics
NPI:1770340887
Name:MAGNANTE, ANNA THERESA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:THERESA
Last Name:MAGNANTE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BELLWETHER WAY STE 240
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2959
Mailing Address - Country:US
Mailing Address - Phone:360-588-2500
Mailing Address - Fax:
Practice Address - Street 1:12 BELLWETHER WAY STE 240
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2959
Practice Address - Country:US
Practice Address - Phone:360-588-2500
Practice Address - Fax:360-785-2016
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007971103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical