MEDICARE: DR. RANDEE ANDERSON PSY.D.

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	106H00000X	Marriage & Family Therapist	274	CO
2	106H00000X	Marriage & Family Therapist	28888	CA

General Provider Information

NPI Number	:	1437208238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDEE ANDERSON PSY.D.

Provider Business Mailing Address
First Line	:	7750 N UNION BLVD
Second Line	:	SUITE 102
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4051
Country	:	US
Telephone Number	:	719-593-2060
Fax Number	:

Provider Business Practice Location Address
First Line	:	7750 N UNION BLVD
Second Line	:	SUITE 102
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4051
Country	:	US
Telephone Number	:	719-593-2060
Fax Number	:

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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