Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY00002820 | WA |
Y | 103T00000X | Psychologist | PY00002820 | WA |
NPI | 1013977313 |
---|---|
Provider Name | Dr. Jeremiah Patrick Norris |
First Address | Tacoma, WA 98498-7213 |
Second Address | Tacoma, WA 98498-7213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 29/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q25785 | (02) | WA |