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NPI Code Detail

MEDICARE: LYNNE M ANDERSON

MEDICARE: LYNNE M ANDERSON
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
11041C0700XClinical Social Worker6801084296MI

General Provider Information

NPI Number : 1033152459
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNNE M ANDERSON
Provider Business Mailing Address
First Line : 1011 MILITARY ST
Second Line :
City : PORT HURON
State : MI
Zip : 48060-5416
Country : US
Telephone Number : 810-985-8900
Fax Number : 810-985-7620
Provider Business Practice Location Address
First Line : 520 SUPERIOR ST
Second Line :
City : PORT HURON
State : MI
Zip : 48060-3838
Country : US
Telephone Number : 810-984-4202
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 07/08/2007

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