Doctor Name: | DONNA MARIE ANDERSON |
NPI Number: | 1053335398 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW, QMHP |
License Number: | |
Business Practice Address: | 400 Ne 7th St Gresham, OR - 970305604 |
Business Phone Number: | 5036615455 |
Business Fax Number: | 5036614959 |
Mailing Address: | 130 Nw Linneman Ave, GRESHAM |
State: | OR |
Postal Code: | 97030 |
Phone Number: | 5032606809 |
Fax Number: | |
NPI Enumeration Date: | 07/27/2006 |
NPI Last Update Date: | 11/28/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |