Provider Demographics
NPI:1538344080
Name:ALLAN, ANNE WINTERBOTHAM
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:WINTERBOTHAM
Last Name:ALLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 POTLATCH RD
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-8439
Mailing Address - Country:US
Mailing Address - Phone:360-376-7997
Mailing Address - Fax:
Practice Address - Street 1:458 POTLATCH RD
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-8439
Practice Address - Country:US
Practice Address - Phone:360-376-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00059917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health