Healthcare Provider Details

I. General information

NPI: 1447362975
Provider Name (Legal Business Name): ANN S ANDERSON LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN S ANDERSON LISW

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W 2ND ST
ROSWELL NM
88201-4609
US

IV. Provider business mailing address

PO BOX 1000
ROSWELL NM
88202-1000
US

V. Phone/Fax

Practice location:
  • Phone: 575-626-9727
  • Fax: 575-208-0780
Mailing address:
  • Phone: 575-626-9727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI3021
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: