Healthcare Provider Details

I. General information

NPI: 1942965058
Provider Name (Legal Business Name): JULIA KORNYUSHIN-ANDERSON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 NE 2ND AVE
CAMAS WA
98607-2310
US

IV. Provider business mailing address

2905 NE 2ND AVE
CAMAS WA
98607-2310
US

V. Phone/Fax

Practice location:
  • Phone: 360-772-5066
  • Fax:
Mailing address:
  • Phone: 360-772-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61151368
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number6509
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number8182
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: