Healthcare Provider Details

I. General information

NPI: 1508450735
Provider Name (Legal Business Name): ANDREA MICHELLE ANDERSON MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2021
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 COURT ST RM 503
NEILLSVILLE WI
54456-1976
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW STE 110
NEW BRIGHTON MN
55112-1789
US

V. Phone/Fax

Practice location:
  • Phone: 715-743-5208
  • Fax: 715-743-5209
Mailing address:
  • Phone: 651-628-9566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11133-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: