Provider Demographics
NPI:1033305040
Name:STATTON, ANNA CATE (MA, QMHP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:CATE
Last Name:STATTON
Suffix:
Gender:F
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:CATE
Other - Last Name:KYGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, QMHP
Mailing Address - Street 1:3180 CENTER ST NE
Mailing Address - Street 2:MANON COUNTY ADULT BEHAVIORAL HEALTH
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:503-588-5351
Mailing Address - Fax:503-364-6552
Practice Address - Street 1:3180 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-588-5351
Practice Address - Fax:503-364-6552
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR123190Medicaid