Provider Demographics
NPI:1942346226
Name:VANDRAGT, BRYAN (PHD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:VANDRAGT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 38TH ST NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8001
Mailing Address - Country:US
Mailing Address - Phone:253-858-9000
Mailing Address - Fax:253-858-9000
Practice Address - Street 1:4807 38TH ST NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8001
Practice Address - Country:US
Practice Address - Phone:253-858-9000
Practice Address - Fax:253-858-9000
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000811103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical