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General NPI Number Information
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NPI Number | 1386145274
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Entity Type | Individual
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Provider Name | KELLY S ANDERSON MA
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Gender | Female
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 7600 NE 41ST ST STE 200
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City | VANCOUVER
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State | WA
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Zip | 98662-6772
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Country | US
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Telephone | 564-208-0023
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N HOWARD ST STE W
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City | SPOKANE
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State | WA
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Zip | 99201-0508
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Country | US
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Telephone | 564-208-0023
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MC61499734
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License Number State | WA
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