Provider Demographics
NPI:1972618536
Name:ANDERSON, ROGER L (MSW)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 S COLUMBIAN WAY
Mailing Address - Street 2:MS: S-182-SW
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-277-6676
Mailing Address - Fax:206-764-2514
Practice Address - Street 1:1660 SOUTH COLUMBIAN WAY
Practice Address - Street 2:MS: S-182-SW
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-9999
Practice Address - Country:US
Practice Address - Phone:206-277-6676
Practice Address - Fax:206-764-2514
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00005022104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker