1518301217 NPI number — MR. DAVID ALLEN ANDERSON M.A., L.P.C., N.C.C.

Table of content: MR. DAVID ALLEN ANDERSON M.A., L.P.C., N.C.C. (NPI 1518301217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518301217 NPI number — MR. DAVID ALLEN ANDERSON M.A., L.P.C., N.C.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
DAVID
Provider Middle Name:
ALLEN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A., L.P.C., N.C.C.
Provider Gender Code:
M

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:
1518301217
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 WILLAMETTE FALLS DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
WEST LINN
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97068-4733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-213-3560
Provider Business Mailing Address Fax Number:
971-256-9918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13568 SW 61ST AVE
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97219-8132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-213-3560
Provider Business Practice Location Address Fax Number:
971-256-9918
Provider Enumeration Date:
04/24/2013

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: 101YM0800X , with the licence number:  C3311 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com