MEDICARE: ANDERSON ROWAN PHD

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	103TC0700X	Clinical Psychologist	752	AL

General Provider Information

NPI Number	:	1356377527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDERSON ROWAN PHD

Provider Business Mailing Address
First Line	:	338 S DAKOTA AVE
Second Line	:
City	:	VANDENBERG AFB
State	:	CA
Zip	:	93437-6307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	338 S DAKOTA AVE
Second Line	:
City	:	VANDENBERG AFB
State	:	CA
Zip	:	93437-6307
Country	:	US
Telephone Number	:	805-606-8217
Fax Number	:	805-606-4390

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	07/08/2007

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