Provider Demographics
NPI:1295849297
Name:ANDIS, SHARLEAN ANNE
Entity Type:Individual
Prefix:
First Name:SHARLEAN
Middle Name:ANNE
Last Name:ANDIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAR
Other - Middle Name:ANNE
Other - Last Name:ANDIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1607 CHESTNUT ST
Mailing Address - Street 2:APARTMENT A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1953
Mailing Address - Country:US
Mailing Address - Phone:425-231-1062
Mailing Address - Fax:425-252-0793
Practice Address - Street 1:2735 10TH ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1413
Practice Address - Country:US
Practice Address - Phone:425-231-1062
Practice Address - Fax:425-252-0793
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00029404101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health