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
1	1041C0700X	Clinical Social Worker	LW00005654	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0007043125	OTHER	WA	AETNA
2	AN9117	OTHER	WA	REGENCE

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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