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General NPI Number Information
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NPI Number | 1972081347
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Entity Type | Individual
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Provider Name | JONAH MICAL ANDERSON LPC, MA, CSAT
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Gender | Male
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Dates
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Enumeration Date | 07/29/2018
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 300 COTTONWOOD AVE STE 8
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City | HARTLAND
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State | WI
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Zip | 53029-2043
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Country | US
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Telephone | 262-302-0016
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Fax |
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Provider Business Mailing Address
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Address Line | 11632 W BLUEMOUND RD
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City | WAUWATOSA
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State | WI
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Zip | 53226-3937
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Country | US
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Telephone | 262-302-0016
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Fax | 608-509-7310
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8529
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 559767
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 559767
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License Number State | WI
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