MEDICARE: MS. VANESSA MARIE ANDERSEN LISW

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	008207	IA

General Provider Information

NPI Number	:	1861839631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VANESSA MARIE ANDERSEN LISW

Provider Business Mailing Address
First Line	:	1220 NE STATION XING STE 114
Second Line	:
City	:	GRIMES
State	:	IA
Zip	:	50111-8013
Country	:	US
Telephone Number	:	153-806-5165
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 NE STATION XING STE 114
Second Line	:
City	:	GRIMES
State	:	IA
Zip	:	50111-8013
Country	:	US
Telephone Number	:	515-380-6516
Fax Number	:

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

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	10/11/2022

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