Provider Demographics
NPI:1407597313
Name:ANDERSON, ANNETTE
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
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 1:809 REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95692-9444
Mailing Address - Country:US
Mailing Address - Phone:530-413-3119
Mailing Address - Fax:
Practice Address - Street 1:345 CROWN POINT CIR STE 14
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-9526
Practice Address - Country:US
Practice Address - Phone:530-478-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program