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NPI Code Detail

MEDICARE: ASHLEY L ANDERSON

MEDICARE: ASHLEY L ANDERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2101Y00000XCounselor

General Provider Information

NPI Number : 1063984714
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY L ANDERSON
Provider Business Mailing Address
First Line : 3809 LAKE EASTBROOK BLVD SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-5931
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3809 LAKE EASTBROOK BLVD SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-5931
Country : US
Telephone Number : 616-604-8492
Fax Number : 616-604-8493
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2018
Last Update Date : 06/19/2024

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Directions to “ ASHLEY L ANDERSON ” Practice Location

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