Healthcare Provider Details

I. General information

NPI: 1285707190
Provider Name (Legal Business Name): MARGUERITE M ANDERSON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W KINNE ST
ELLSWORTH WI
54011
US

IV. Provider business mailing address

PO BOX 670
ELLSWORTH WI
54011-0670
US

V. Phone/Fax

Practice location:
  • Phone: 715-273-6770
  • Fax: 715-273-6862
Mailing address:
  • Phone: 715-273-6770
  • Fax: 715-273-6770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12268
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: