MEDICARE: JENNIFER 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
1	171M00000X	Case Manager/Care Coordinator
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	1245402031	CA

General Provider Information

NPI Number	:	1245402031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANDERSON

Provider Business Mailing Address
First Line	:	3024 WILLOW PASS RD
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94519-2588
Country	:	US
Telephone Number	:	925-363-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1305 MACDONALD AVE
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94801-3120
Country	:	US
Telephone Number	:	510-412-3200
Fax Number	:

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

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	01/19/2010

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Directions to “ JENNIFER ANDERSON ” Practice Location

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