Provider Demographics
NPI:1730365776
Name:ALTMAN, ADRIANNE MICHELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:ADRIANNE
Middle Name:MICHELLE
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15408 MAIN ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-9024
Mailing Address - Country:US
Mailing Address - Phone:425-224-5458
Mailing Address - Fax:425-582-7517
Practice Address - Street 1:15408 MAIN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-9024
Practice Address - Country:US
Practice Address - Phone:425-224-5458
Practice Address - Fax:425-582-7517
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-19
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21355103T00000X
WAPY60134952103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist