Provider Demographics
NPI:1306246392
Name:GERDIN, TYLER (PSYD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:GERDIN
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 1:701 W 7TH AVE STE 160A
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2835
Mailing Address - Country:US
Mailing Address - Phone:503-653-0631
Mailing Address - Fax:503-653-1464
Practice Address - Street 1:701 W 7TH AVE STE 160A
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2835
Practice Address - Country:US
Practice Address - Phone:509-676-4313
Practice Address - Fax:509-676-4314
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2569103TC0700X
WAPY61111308103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical