Healthcare Provider Details

I. General information

NPI: 1285447987
Provider Name (Legal Business Name): NICHOLAS ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 CHADWICK RD STE 2
CEDAR FALLS IA
50613-8091
US

IV. Provider business mailing address

4615 CHADWICK RD STE 2
CEDAR FALLS IA
50613-8091
US

V. Phone/Fax

Practice location:
  • Phone: 319-255-5660
  • Fax:
Mailing address:
  • Phone: 319-255-5660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number116499
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: