Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PY00001859 | WA |
N | 103T00000X | Psychologist | PY00001859 | WA |
N | 103G00000X | Clinical Psychologist | PY00001859 | WA |
N | 103TC0700X | Clinical Psychologist | PY00001859 | WA |
N | 103TH0100X | Health Service | PY00001859 | WA |
NPI | 1073534079 |
---|---|
Provider Name | Dr. Donna May Lidren |
First Address | Tacoma, WA 98405 |
Second Address | Tacoma, WA 98405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0076471 | DEPT OF L&I (01) | WA |
LI0788 | REGENCE BS (01) | WA |
S24329 | (02) |