Healthcare Provider Details

I. General information

NPI: 1255258679
Provider Name (Legal Business Name): KATLYNN M ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 I 75 BUSINESS SPUR # MI49783
SAULT SAINTE MARIE MI
49783-3536
US

IV. Provider business mailing address

17077 S MACKINAC TRL
RUDYARD MI
49780-9396
US

V. Phone/Fax

Practice location:
  • Phone: 800-645-4737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: