Provider Demographics
NPI:1316057540
Name:DALRYMPLE, ANNELLA TIGARD (PHD)
Entity type:Individual
Prefix:DR
First Name:ANNELLA
Middle Name:TIGARD
Last Name:DALRYMPLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3704
Mailing Address - Country:US
Mailing Address - Phone:707-829-1053
Mailing Address - Fax:707-433-5515
Practice Address - Street 1:171 N HIGH ST
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3704
Practice Address - Country:US
Practice Address - Phone:707-829-1053
Practice Address - Fax:707-433-5515
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical