MEDICARE: JENNIFER ANDERSON LMSW

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	1041C0700X	Clinical Social Worker	6801094827	MI

General Provider Information

NPI Number	:	1578273637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANDERSON LMSW

Provider Business Mailing Address
First Line	:	32560 STEFANO DR
Second Line	:
City	:	BROWNSTOWN
State	:	MI
Zip	:	48173-8631
Country	:	US
Telephone Number	:	734-658-1848
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 N MACOMB ST
Second Line	:
City	:	MONROE
State	:	MI
Zip	:	48162-2929
Country	:	US
Telephone Number	:	734-258-3518
Fax Number	:

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

Provider Enumeration Date	:	11/30/2022
Last Update Date	:	11/30/2022

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