Healthcare Provider Details

I. General information

NPI: 1306904818
Provider Name (Legal Business Name): JANIS D. ANDERSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANIS D.A. HOGLUND MA

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 CHARLES ST
BRAINERD MN
56401-3208
US

IV. Provider business mailing address

645 2ND ST SW
PERHAM MN
56573-1101
US

V. Phone/Fax

Practice location:
  • Phone: 218-855-1247
  • Fax: 218-855-1248
Mailing address:
  • Phone: 218-346-5384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5118
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: