Healthcare Provider Details

I. General information

NPI: 1285985085
Provider Name (Legal Business Name): ERIK RYAN ANDERSON LMSW (MI), LCSW (AZ)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 E HESS LAKE DR
GRANT MI
49327-8617
US

IV. Provider business mailing address

1357 E HESS LAKE DR
GRANT MI
49327-8617
US

V. Phone/Fax

Practice location:
  • Phone: 734-883-8415
  • Fax: 734-822-0199
Mailing address:
  • Phone: 734-883-8415
  • Fax: 734-822-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095470
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20318
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: