MEDICARE: VANESSA JEAN 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
1	106S00000X	Behavior Technician	VG636777	OH

General Provider Information

NPI Number	:	1649127804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA JEAN ANDERSON

Provider Business Mailing Address
First Line	:	618 DENNIS ST APT 1
Second Line	:
City	:	ADRIAN
State	:	MI
Zip	:	49221-3373
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	618 DENNIS ST APT 1
Second Line	:
City	:	ADRIAN
State	:	MI
Zip	:	49221-3373
Country	:	US
Telephone Number	:	517-312-1711
Fax Number	:

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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Directions to “ VANESSA JEAN ANDERSON ” Practice Location

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