Provider Demographics
NPI:1699251413
Name:INGER, ANNA (RADT R1265380917)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:INGER
Suffix:
Gender:F
Credentials:RADT R1265380917
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 QUETTA AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1256
Mailing Address - Country:US
Mailing Address - Phone:650-208-3285
Mailing Address - Fax:
Practice Address - Street 1:1659 SCOTT BLVD STE 210
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4489
Practice Address - Country:US
Practice Address - Phone:408-281-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-15
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1265380917101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)