Provider Demographics
NPI:1104583608
Name:DENNISON, TRAVIS DYLAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:DYLAN
Last Name:DENNISON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4806 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-3204
Mailing Address - Country:US
Mailing Address - Phone:206-909-1320
Mailing Address - Fax:
Practice Address - Street 1:2420 S UNION AVE STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1306
Practice Address - Country:US
Practice Address - Phone:253-752-7320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61163194103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical