=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619031069
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARET H. ANDERSON PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2006
-----------------------------------------------------
Last Update Date | 04/25/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1210 DRY HOLLOW ROAD SUITE 2
-----------------------------------------------------
City | THE DALLES
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97058-3167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-298-2298
-----------------------------------------------------
Fax | 541-296-1080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1102
-----------------------------------------------------
City | GOLDENDALE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98620-1102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-298-2298
-----------------------------------------------------
Fax | 541-296-1080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY00002800
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 1820
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------