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General NPI Number Information
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NPI Number | 1477563344
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTH & SERVICES WASHINGTON
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 1818 E REZANOF DR
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City | KODIAK
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State | AK
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Zip | 99615-6505
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Country | US
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Telephone | 907-481-2400
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Fax | 907-481-2419
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Provider Business Mailing Address
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Address Line | PO BOX 3290
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City | PORTLAND
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State | OR
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Zip | 97208-3290
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Country | US
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Telephone | 907-486-9500
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Fax |
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Authorized Official
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Title or Position | ASSISTANT SECRETARY OF ENROLLMENTS
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Name | MR. DONALD WAYNE ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 297340
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 297340
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 297340
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License Number State | AK
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 297340
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License Number State | AK
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 297340
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License Number State | AK
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