Healthcare Provider Details

I. General information

NPI: 1770690380
Provider Name (Legal Business Name): DENNIS O. ANDERSEN L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NORTHWAY DRIVE SUITE 1
SAINT CLOUD MN
56303-1218
US

IV. Provider business mailing address

1500 NORTHWAY DRIVE SUITE 1
SAINT CLOUD MN
56303-1218
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-4321
  • Fax: 320-240-8525
Mailing address:
  • Phone: 320-253-4321
  • Fax: 320-240-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: