Healthcare Provider Details

I. General information

NPI: 1275334567
Provider Name (Legal Business Name): ANDREW JORDAN EGGEBRAATEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 NORTHEAST 44TH STREET OFFICE 12
VANCOUVER WA
98663
US

IV. Provider business mailing address

606 FLINT WAY
VANCOUVER WA
98664-1235
US

V. Phone/Fax

Practice location:
  • Phone: 425-236-3296
  • Fax:
Mailing address:
  • Phone: 425-236-3296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70179900
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: