Provider Demographics
NPI:1366545246
Name:CHOLERTON, BRENNA AILIENE (PHD)
Entity type:Individual
Prefix:DR
First Name:BRENNA
Middle Name:AILIENE
Last Name:CHOLERTON
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 1:20 RAFT ISLAND DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-5918
Mailing Address - Country:US
Mailing Address - Phone:253-582-8440
Mailing Address - Fax:253-589-4073
Practice Address - Street 1:9600 VETERANS DR SW
Practice Address - Street 2:GRECC-A-182
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0003
Practice Address - Country:US
Practice Address - Phone:253-582-8440
Practice Address - Fax:253-589-4073
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2589103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical