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NPI Code Detail

MEDICARE: ALEIGHA M ANDERSEN SUDPT

MEDICARE: ALEIGHA M ANDERSEN SUDPT
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
1101Y00000XCounselorCG61653070WA
2101YA0400XAddiction (Substance Use Disorder) CounselorCP61491970WA

General Provider Information

NPI Number : 1629723457
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEIGHA M ANDERSEN SUDPT
Provider Business Mailing Address
First Line : PO BOX 2394
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-8455
Country : US
Telephone Number : 360-200-5419
Fax Number : 360-200-6736
Provider Business Practice Location Address
First Line : 1340 12TH AVE STE 100
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-3820
Country : US
Telephone Number : 360-998-2047
Fax Number : 360-200-6736
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2022
Last Update Date : 01/13/2025

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Directions to “ ALEIGHA M ANDERSEN SUDPT” Practice Location

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