Healthcare Provider Details

I. General information

NPI: 1447174057
Provider Name (Legal Business Name): JENNIFER LEE ANDERSON M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E MAPLE ST
HOLLY MI
48442-1777
US

IV. Provider business mailing address

6228 FLEMINGS LAKE RD
CLARKSTON MI
48346-1624
US

V. Phone/Fax

Practice location:
  • Phone: 248-328-3600
  • Fax: 248-328-3604
Mailing address:
  • Phone: 248-709-8563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101002790
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: