Provider Demographics
NPI:1861369662
Name:ANZALDUA, ADRENNA NICOLE
Entity type:Individual
Prefix:
First Name:ADRENNA
Middle Name:NICOLE
Last Name:ANZALDUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 MARKET ST STE D
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-5451
Mailing Address - Country:US
Mailing Address - Phone:360-391-7919
Mailing Address - Fax:
Practice Address - Street 1:2226 MARKET ST STE D
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5451
Practice Address - Country:US
Practice Address - Phone:360-391-7919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor