Provider Demographics
NPI:1215698725
Name:HAMILTON, IAN ROBERT
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:ROBERT
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3837 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2138
Mailing Address - Country:US
Mailing Address - Phone:253-235-0156
Mailing Address - Fax:
Practice Address - Street 1:3837 S 12TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2138
Practice Address - Country:US
Practice Address - Phone:253-235-0156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWDL6NPB1SBOtherDRIVERS LICENSE