Provider Demographics
NPI:1467082107
Name:ANDERSON, COURTNEY JEAN
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JEAN
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 1:433 NW BUCKLIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-9184
Mailing Address - Country:US
Mailing Address - Phone:360-865-1645
Mailing Address - Fax:
Practice Address - Street 1:433 NW BUCKLIN HILL RD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-9184
Practice Address - Country:US
Practice Address - Phone:360-865-1645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst