Healthcare Provider Details

I. General information

NPI: 1669867511
Provider Name (Legal Business Name): KEVIN SCOTT ANDERSON MA, EDS, LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E 2ND ST STE 226
WINONA MN
55987-6510
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 Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP3823
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLP3823
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: