Healthcare Provider Details

I. General information

NPI: 1720097611
Provider Name (Legal Business Name): MICHAEL FLOYD ANDERSON MS LCSW LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W6144 AEROTECH DR
APPLETON WI
54914-7503
US

IV. Provider business mailing address

1090 S TAMIAMI TRL
SARASOTA FL
34236-9116
US

V. Phone/Fax

Practice location:
  • Phone: 920-733-2065
  • Fax: 920-574-3273
Mailing address:
  • Phone: 904-605-4986
  • Fax: 941-460-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3911123
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: