Provider Demographics
NPI:1831422930
Name:LANTZ, JEANETTE I (PHD)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:I
Last Name:LANTZ
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:PO BOX 7899
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98417-0899
Mailing Address - Country:US
Mailing Address - Phone:253-792-1077
Mailing Address - Fax:
Practice Address - Street 1:5123 N 45TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-3717
Practice Address - Country:US
Practice Address - Phone:253-792-1077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23674103T00000X, 103TB0200X
WAPY60502318103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral