Healthcare Provider Details

I. General information

NPI: 1215477013
Provider Name (Legal Business Name): JENNIFER ANDERSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E 2ND ST
LIBBY MT
59923-2010
US

IV. Provider business mailing address

320 E 2ND ST
LIBBY MT
59923-2010
US

V. Phone/Fax

Practice location:
  • Phone: 406-283-6900
  • Fax: 406-293-6622
Mailing address:
  • Phone: 406-283-6900
  • Fax: 406-293-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-23210
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: