Provider Demographics
NPI:1215684485
Name:RIDDLE-ANDERSON, CRYSTAL MARIE (NA-C, P-TA, SUD, CPC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARIE
Last Name:RIDDLE-ANDERSON
Suffix:
Gender:F
Credentials:NA-C, P-TA, SUD, CPC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:M
Other - Last Name:RIDDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NA-C, PT-A, CPC,SUD
Mailing Address - Street 1:1348 SUNRISE HILL LN # A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-8788
Mailing Address - Country:US
Mailing Address - Phone:509-906-3471
Mailing Address - Fax:
Practice Address - Street 1:1348 SUNRISE HILL LN
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-8788
Practice Address - Country:US
Practice Address - Phone:208-217-1079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's Aide