Healthcare Provider Details

I. General information

NPI: 1871744375
Provider Name (Legal Business Name): JONATHAN W ANDERSON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 S COWLEY ST
SPOKANE WA
99202-1330
US

IV. Provider business mailing address

711 S COWLEY ST
SPOKANE WA
99202-1330
US

V. Phone/Fax

Practice location:
  • Phone: 509-473-6159
  • Fax:
Mailing address:
  • Phone: 509-473-6159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY60001677
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60001677
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: