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NPI Code Detail

MEDICARE: ERIC ANDERSON LICSW

MEDICARE: ERIC ANDERSON 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 WorkerLW00006371WA

General Provider Information

NPI Number : 1922156967
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC ANDERSON LICSW
Provider Business Mailing Address
First Line : 2215 BROADWAY ST
Second Line :
City : VANCOUVER
State : WA
Zip : 98663-3226
Country : US
Telephone Number : 360-906-7156
Fax Number : 360-696-3658
Provider Business Practice Location Address
First Line : 2215 BROADWAY ST
Second Line :
City : VANCOUVER
State : WA
Zip : 98663-3226
Country : US
Telephone Number : 360-906-7156
Fax Number : 360-696-3658
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 07/08/2007

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Directions to “ ERIC ANDERSON LICSW” Practice Location

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