Healthcare Provider Details

I. General information

NPI: 1902287824
Provider Name (Legal Business Name): ALTAIRE ANDERSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 W MCGRAW ST STE 212
SEATTLE WA
98199-3239
US

IV. Provider business mailing address

18665 116TH AVE SE
RENTON WA
98058-7149
US

V. Phone/Fax

Practice location:
  • Phone: 206-453-4882
  • Fax:
Mailing address:
  • Phone: 206-218-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberCG60577463
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: