Healthcare Provider Details

I. General information

NPI: 1396012720
Provider Name (Legal Business Name): LINDA M ANDERSON CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6228 E OLD SCHOOL RD
WELLPINIT WA
99040
US

IV. Provider business mailing address

PO BOX 540
WELLPINIT WA
99040-0540
US

V. Phone/Fax

Practice location:
  • Phone: 509-258-7502
  • Fax: 509-258-4480
Mailing address:
  • Phone: 509-258-7502
  • Fax: 509-258-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00003317
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: