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General NPI Number Information
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NPI Number | 1285741819
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Entity Type | Individual
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Provider Name | GREGORY T ANDERSON LP
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Gender | Male
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 214 W SUPERIOR ST SKYWALK LEVEL
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City | DULUTH
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State | MN
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Zip | 55802-1904
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Country | US
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Telephone | 218-722-2273
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Fax | 218-726-1183
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Provider Business Mailing Address
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Address Line | 1401 EAST FIRST STREET
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City | DULUTH
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State | MN
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Zip | 55805
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Country | US
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Telephone | 218-728-4491
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Fax | 218-728-4404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | LP1457
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7341
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License Number State | MN
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