Healthcare Provider Details

I. General information

NPI: 1861308348
Provider Name (Legal Business Name): KATELYN M ANDERSEN NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18898 SPYGLASS RD
HIDDEN VALLEY LAKE CA
95467-8661
US

IV. Provider business mailing address

18898 SPYGLASS RD
HIDDEN VALLEY LAKE CA
95467-8661
US

V. Phone/Fax

Practice location:
  • Phone: 208-860-8442
  • Fax:
Mailing address:
  • Phone: 208-860-8442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: