Provider Demographics
NPI:1437465770
Name:ANDERSON, AMANDA N (MA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:COSMOPOLIS
Mailing Address - State:WA
Mailing Address - Zip Code:98537-0558
Mailing Address - Country:US
Mailing Address - Phone:360-612-0495
Mailing Address - Fax:
Practice Address - Street 1:904 ALTENAU STREET
Practice Address - Street 2:
Practice Address - City:COSMOPOLIS
Practice Address - State:WA
Practice Address - Zip Code:98537
Practice Address - Country:US
Practice Address - Phone:360-612-0495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health