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General NPI Number Information
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NPI Number | 1457574527
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Entity Type | Individual
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Provider Name | PERRY J ANDERSON JR. MSW
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 100 POLK COUNTY PLZ SUITE 50
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City | BALSAM LAKE
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State | WI
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Zip | 54810-9071
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Country | US
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Telephone | 715-485-8445
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Fax | 715-485-8490
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Provider Business Mailing Address
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Address Line | 440 105TH ST
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City | AMERY
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State | WI
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Zip | 54001-4010
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Country | US
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Telephone | 715-268-5165
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6798-123
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License Number State | WI
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