1215123435 NPI number — MRS. JUDITH ANN CANTER LCSW

Table of content: MRS. JUDITH ANN CANTER LCSW (NPI 1215123435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215123435 NPI number — MRS. JUDITH ANN CANTER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANTER
Provider First Name:
JUDITH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215123435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 923
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA CENTER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98629-0923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-903-7415
Provider Business Mailing Address Fax Number:
360-263-3938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2417 BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98663-3228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-903-7415
Provider Business Practice Location Address Fax Number:
360-263-3938
Provider Enumeration Date:
09/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LW00009073 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: L4029 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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