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NPI Code Detail

MEDICARE: TIMOTHY P ANDERSON MA, LADC-S

MEDICARE: TIMOTHY P ANDERSON MA, LADC-S
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
1101YA0400XAddiction (Substance Use Disorder) Counselor304740MN

General Provider Information

NPI Number : 1376146985
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY P ANDERSON MA, LADC-S
Provider Business Mailing Address
First Line : 5628 SILAS DENT RD NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-0195
Country : US
Telephone Number : 651-724-5648
Fax Number :
Provider Business Practice Location Address
First Line : 3737 40TH AVE NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-1772
Country : US
Telephone Number : 651-724-5648
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2020
Last Update Date : 11/17/2020

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