Provider Demographics
NPI:1487705455
Name:CHAFFEE, RUTH (PHD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:CHAFFEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:CHAFFEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:P.O. BOX 7189
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98417-0189
Mailing Address - Country:US
Mailing Address - Phone:253-756-8862
Mailing Address - Fax:253-756-8886
Practice Address - Street 1:2702 1/2 N PROCTOR ST
Practice Address - Street 2:SUITE E
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-5243
Practice Address - Country:US
Practice Address - Phone:253-756-8862
Practice Address - Fax:253-756-8886
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1258103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4586582OtherAETNA
WACH0129OtherREGENCE
WA11582419OtherCAQH
WA145154200OtherDEPARTMENT OF LABOR
G8879118Medicare UPIN