MEDICARE: CARRIE ROCHELLE ANDERSON MSED., LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	01543	MN

General Provider Information

NPI Number	:	1023462603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE ROCHELLE ANDERSON MSED., LPC, NCC

Provider Business Mailing Address
First Line	:	PO BOX 27
Second Line	:	401 WEST STREET
City	:	JACKSON
State	:	MN
Zip	:	56143-0027
Country	:	US
Telephone Number	:	507-847-2423
Fax Number	:	507-847-2422

Provider Business Practice Location Address
First Line	:	401 WEST ST
Second Line	:	SUITE 0115
City	:	JACKSON
State	:	MN
Zip	:	56143-1219
Country	:	US
Telephone Number	:	507-847-2423
Fax Number	:	507-847-2422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	04/20/2016

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