Healthcare Provider Details

I. General information

NPI: 1699695346
Provider Name (Legal Business Name): KEVIN AND SANDY ANDERSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 4TH AVE NW STE 10
AUSTIN MN
55912-3140
US

IV. Provider business mailing address

902 E 2ND ST STE 226
WINONA MN
55987-6510
US

V. Phone/Fax

Practice location:
  • Phone: 507-440-0134
  • Fax: 855-748-3132
Mailing address:
  • Phone: 507-440-0134
  • Fax: 855-748-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN SCOTT ANDERSON
Title or Position: LICENSED PSYCHOLOGIST/OWNER
Credential: MA, EDS, LP
Phone: 507-440-0134