Organization
ANICCA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH L ANDERT LCSW (MANAGING MEMBER)
(503) 421-5904
Entity
Organization
Contact information
Practice address
1020 SW TAYLOR ST STE 685, PORTLAND, OR 97205-2511
(503) 421-5904
Mailing address
1020 SW TAYLOR ST STE 685, PORTLAND, OR 97205-2511
(503) 421-5904
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1423
OR
Other
Enumeration date
10/08/2010
Last updated
10/08/2010
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