Provider Demographics
NPI:1578388526
Name:RIDGEWAY-ANDERSON, STEVEN ROBERT I
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ROBERT
Last Name:RIDGEWAY-ANDERSON
Suffix:I
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 1:2280 WA-821
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901
Mailing Address - Country:US
Mailing Address - Phone:509-457-0990
Mailing Address - Fax:
Practice Address - Street 1:1007 S 21ST AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4165
Practice Address - Country:US
Practice Address - Phone:509-406-6717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61593039101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)