Individual
DR. MAUREEN TARA NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
850 W. MAPLE ST., MEDICAL LAKE, WA 99022
(509) 565-4000
Mailing address
P.O. BOX 800, 850 W. MAPLE ST., MEDICAL LAKE, WA 99022
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY60778414
WA
Other
Enumeration date
06/10/2021
Last updated
06/10/2021
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