Provider Demographics
NPI:1033369459
Name:ZANDER, ANNIE MARIE (MSW, CADC III)
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:MARIE
Last Name:ZANDER
Suffix:
Gender:F
Credentials:MSW, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39084 PROCTOR BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-8064
Mailing Address - Country:US
Mailing Address - Phone:503-826-8500
Mailing Address - Fax:413-215-5103
Practice Address - Street 1:39084 PROCTOR BLVD STE E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-8064
Practice Address - Country:US
Practice Address - Phone:503-826-8500
Practice Address - Fax:413-215-5103
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11-03-71101YA0400X
ORL102161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)