Provider Demographics
NPI:1114706025
Name:ANDERSON, ADELAIDE LENORE
Entity Type:Individual
Prefix:MISS
First Name:ADELAIDE
Middle Name:LENORE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 29TH AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5068
Mailing Address - Country:US
Mailing Address - Phone:509-833-0756
Mailing Address - Fax:
Practice Address - Street 1:3704 N 35TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-6033
Practice Address - Country:US
Practice Address - Phone:206-580-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician