Crystal Marie Riddle-Anderson, NA-C, P-TA, SUD, CPC

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

1348 Sunrise Hill LN
Newport, WA 99156-8788

Phone

(208) 217-1079

NPI assigned

Mar 7, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Other names 1

• Crystal M Riddle Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1215684485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1348 SUNRISE HILL LN # A",
            "city": "NEWPORT",
            "state": "WA",
            "postal_code": "991568788",
            "telephone_number": "509-906-3471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1348 SUNRISE HILL LN",
            "city": "NEWPORT",
            "state": "WA",
            "postal_code": "991568788",
            "telephone_number": "208-217-1079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDDLE-ANDERSON",
        "first_name": "CRYSTAL",
        "middle_name": "MARIE",
        "credential": "NA-C, P-TA, SUD, CPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-07",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "washingtonstatepeercounselingservices.com",
            "affiliation": "N",
            "endpointDescription": "washingtonstatepeercounselingservices.com",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "washingtonstatepeercounselingservices.com",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "washingtonstatepeercounselingservices.com",
            "address_1": "1348 Sunrise Hill Ln",
            "city": "Newport",
            "state": "WA",
            "country_code": "US",
            "postal_code": "991568788",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "washingtonstatepeercounselingservices.om",
            "affiliation": "N",
            "endpointDescription": "washingtonstatepeercounselingservices.com",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "washingtonstatepeercounselingservices.com",
            "address_1": "1348 Sunrise Hill Ln # A",
            "city": "Newport",
            "state": "WA",
            "country_code": "US",
            "postal_code": "991568788",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "RIDDLE",
            "middle_name": "M",
            "credential": "NA-C, PT-A, CPC,SUD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.