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General NPI Number Information
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NPI Number | 1992808844
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Entity Type | Individual
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Provider Name | JANET MARIE ANDERSON LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 529 W. COUNTY ROAD E SUITE C
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City | SHOREVIEW
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State | MN
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Zip | 55126-1125
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Country | US
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Telephone | 651-287-6022
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Fax | 651-486-3954
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Provider Business Mailing Address
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Address Line | 5048 14TH AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55417-1125
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Country | US
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Telephone | 612-702-3706
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 15441
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License Number State | MN
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