Provider Demographics
NPI:1609200112
Name:ELDER, ANNIE ROSE
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:ROSE
Last Name:ELDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:ROSE
Other - Last Name:EDONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3232 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:WA
Mailing Address - Zip Code:98244-9603
Mailing Address - Country:US
Mailing Address - Phone:360-202-0067
Mailing Address - Fax:
Practice Address - Street 1:1200 HARRIS AVE STE 411
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-202-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health