Individual
COLLEEN RUSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3224 6TH AVE, TACOMA, WA 98406-5902
(253) 579-8278
Mailing address
3516 ROSS AVE, GIG HARBOR, WA 98332-2105
(602) 509-5660
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY60820191
WA
Other
Enumeration date
10/02/2017
Last updated
08/29/2018
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