Healthcare Provider Details

I. General information

NPI: 1508774613
Provider Name (Legal Business Name): EMILY ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 SW 5TH ST
BATTLE GROUND WA
98604-3006
US

IV. Provider business mailing address

1618 SW 5TH ST
BATTLE GROUND WA
98604-3006
US

V. Phone/Fax

Practice location:
  • Phone: 360-518-6569
  • Fax:
Mailing address:
  • Phone: 360-518-6569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number70148578
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: