Provider Demographics
NPI:1336261452
Name:ANDERSON, CHAD DELOY (LMSW, MAC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:DELOY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMSW, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 B ST
Mailing Address - Street 2:
Mailing Address - City:PLUMMER
Mailing Address - State:ID
Mailing Address - Zip Code:83851
Mailing Address - Country:US
Mailing Address - Phone:208-686-1449
Mailing Address - Fax:208-686-5813
Practice Address - Street 1:3520 N 15TH ST APT C1
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-6629
Practice Address - Country:US
Practice Address - Phone:208-686-1449
Practice Address - Fax:208-686-5813
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-26946104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker