Provider Demographics
NPI:1619797131
Name:ANDERSON, NATHANIEL JOSEPH
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:JOSEPH
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 PIKE ST SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-5831
Mailing Address - Country:US
Mailing Address - Phone:206-696-9072
Mailing Address - Fax:
Practice Address - Street 1:110 2ND ST SW STE 140
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-5203
Practice Address - Country:US
Practice Address - Phone:253-737-5078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician