Provider Demographics
NPI:1578018545
Name:WETTERAU, ANDREA (LICSW, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:WETTERAU
Suffix:
Gender:F
Credentials:LICSW, LMHC
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSWAZC
Mailing Address - Street 1:2107 16TH AVE S.
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144
Mailing Address - Country:US
Mailing Address - Phone:206-450-2719
Mailing Address - Fax:
Practice Address - Street 1:2107 16TH AVE S.
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144
Practice Address - Country:US
Practice Address - Phone:206-450-2719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60888603101YM0800X
WASC605869381041C0700X
WALW609064651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health