Provider Demographics
NPI:1619031069
Name:ANDERSON, MARGARET H (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:H
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSYD
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 1102
Mailing Address - Street 2:
Mailing Address - City:GOLDENDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98620-1102
Mailing Address - Country:US
Mailing Address - Phone:541-298-2298
Mailing Address - Fax:541-296-1080
Practice Address - Street 1:1210 DRY HOLLOW ROAD SUITE 2
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3167
Practice Address - Country:US
Practice Address - Phone:541-298-2298
Practice Address - Fax:541-296-1080
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002800103TC0700X
OR1820103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164936Medicaid
OR0000WDBCHMedicare ID - Type UnspecifiedGROUP NUMBER