Healthcare Provider Details

I. General information

NPI: 1225503964
Provider Name (Legal Business Name): SOPHIE JEAN ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 MAIN ST
VANCOUVER WA
98660-3136
US

IV. Provider business mailing address

914 MAIN ST
VANCOUVER WA
98660-3136
US

V. Phone/Fax

Practice location:
  • Phone: 503-878-8885
  • Fax: 971-297-1360
Mailing address:
  • Phone: 503-878-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR8285
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMC61564968
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: