Healthcare Provider Details

I. General information

NPI: 1740563113
Provider Name (Legal Business Name): HOLLY LEANNE ANDERSON-CALDWELL LCSW, CDC I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 NEW WAY
KLAMATH FALLS OR
97601-9382
US

IV. Provider business mailing address

6000 NEW WAY
KLAMATH FALLS OR
97601-9382
US

V. Phone/Fax

Practice location:
  • Phone: 541-884-1841
  • Fax: 541-851-3988
Mailing address:
  • Phone: 541-884-1841
  • Fax: 541-851-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61259040
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL7798
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number925
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: