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NPI Code Detail

MEDICARE: MR. RON ANDERS LICSW

MEDICARE:  MR. RON  ANDERS  LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLW00005654WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10007043125OTHERWAAETNA
2AN9117OTHERWAREGENCE

General Provider Information

NPI Number : 1356477053
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RON ANDERS LICSW
Provider Business Mailing Address
First Line : 3701 S HUDSON ST APT 209
Second Line :
City : SEATTLE
State : WA
Zip : 98118-2162
Country : US
Telephone Number : 206-860-8748
Fax Number :
Provider Business Practice Location Address
First Line : 3701 S HUDSON ST APT 209
Second Line :
City : SEATTLE
State : WA
Zip : 98118-2162
Country : US
Telephone Number : 206-860-8748
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 11/21/2020

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Directions to “ MR. RON ANDERS LICSW” Practice Location

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