Provider Demographics
NPI:1194088005
Name:TUCKER, VANESSA EVE (PHD, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:EVE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:DR
Other - First Name:VANESSA
Other - Middle Name:EVE
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2732 38TH ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-1943
Mailing Address - Country:US
Mailing Address - Phone:253-391-6784
Mailing Address - Fax:877-768-7946
Practice Address - Street 1:2732 38TH ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-1943
Practice Address - Country:US
Practice Address - Phone:253-391-6784
Practice Address - Fax:877-768-7946
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-17
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-12-10501103K00000X
WABA60811474103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABA60811474OtherHEALTH CARE AUTHORITY HCA
WA1-12-10501OtherBOARD CERTIFIED BEHAVIOR ANALYST