Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PY00001412 | WA |
NPI | 1013089192 |
---|---|
Provider Name | Dr. Earline Anderson |
First Address | Issaquah, WA 98027-3271 |
Second Address | Issaquah, WA 98027-3271 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5284674 | AETNA US HEALTHCARE ID (01) | |
AN9961 | REGENCE PIN # (01) |