Basic Information
| Provider Information | |||||||||
| NPI: | 1437342912 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ACEBEDO | ||||||||
| FirstName: | AIMEE | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1019 PACIFIC AVE | ||||||||
| Address2: | STE. 300 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984024443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537221576 | ||||||||
| FaxNumber: | 2537221546 | ||||||||
| Practice Location | |||||||||
| Address1: | 1019 PACIFIC AVE | ||||||||
| Address2: | STE. 300 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984024443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537221576 | ||||||||
| FaxNumber: | 2537221546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2007 | ||||||||
| LastUpdateDate: | 09/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103TC0700X | PSY26232 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | PY60642547 | WA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.