Provider Demographics
NPI:1205312196
Name:ANDERSON, JAYME (CSWA)
Entity type:Individual
Prefix:MRS
First Name:JAYME
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6313 NE 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-5492
Mailing Address - Country:US
Mailing Address - Phone:360-481-9083
Mailing Address - Fax:
Practice Address - Street 1:6313 NE 87TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-5492
Practice Address - Country:US
Practice Address - Phone:360-481-9083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-14
Last Update Date:2018-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASWAA.SA.60880947104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker