Provider Demographics
NPI:1861038317
Name:VANDERWEY, TIANNA RENEE
Entity type:Individual
Prefix:
First Name:TIANNA
Middle Name:RENEE
Last Name:VANDERWEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3722 S 39TH PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-7632
Mailing Address - Country:US
Mailing Address - Phone:503-913-1993
Mailing Address - Fax:
Practice Address - Street 1:3722 S 39TH PL
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-7632
Practice Address - Country:US
Practice Address - Phone:503-913-1993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA615143761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical