1487705455 NPI number — RUTH CHAFFEE PH.D.

Table of content: RUTH CHAFFEE PH.D. (NPI 1487705455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487705455 NPI number — RUTH CHAFFEE PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAFFEE
Provider First Name:
RUTH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAFFEE
Provider Other First Name:
RUTH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1487705455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 7189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98417-0189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-756-8862
Provider Business Mailing Address Fax Number:
253-756-8886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2702 1/2 N PROCTOR ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98407-5243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-756-8862
Provider Business Practice Location Address Fax Number:
253-756-8886
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1258 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4586582 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CH0129 . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 11582419 . This is a "CAQH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 145154200 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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