MEDICARE: MRS. NATALIE DIANE ANDERSON M.S., LMFT

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
1	106H00000X	Marriage & Family Therapist	15-228	WI
2	106H00000X	Marriage & Family Therapist	841-124	WI

General Provider Information

NPI Number	:	1205093994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATALIE DIANE ANDERSON M.S., LMFT

Provider Business Mailing Address
First Line	:	4035 N ELMHURST RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1729
Country	:	US
Telephone Number	:	414-795-3578
Fax Number	:

Provider Business Practice Location Address
First Line	:	4035 N ELMHURST RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1729
Country	:	US
Telephone Number	:	414-795-3578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	07/07/2010

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