Provider Demographics
NPI:1063624104
Name:ERNST, JOHN ALLAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALLAN
Last Name:ERNST
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:1717 S J ST # MS 02-12
Mailing Address - Street 2:PO BOX 2197, ST JOSEPH MEDICAL CENTER
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4933
Mailing Address - Country:US
Mailing Address - Phone:253-426-6762
Mailing Address - Fax:253-426-6224
Practice Address - Street 1:1717 S J ST # MS 02-12
Practice Address - Street 2:ST JOSEPH MEDICAL CENTER
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4933
Practice Address - Country:US
Practice Address - Phone:253-426-6762
Practice Address - Fax:253-426-6224
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA953103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist