MEDICARE: ROBERT JOSHUA ANDERSON CCC-SLP

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	235Z00000X	Speech-Language Pathologist	10253	MN

General Provider Information

NPI Number	:	1558026062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT JOSHUA ANDERSON CCC-SLP

Provider Business Mailing Address
First Line	:	1316 BALSAM TRL E
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55123-1710
Country	:	US
Telephone Number	:	218-686-8840
Fax Number	:

Provider Business Practice Location Address
First Line	:	3514 LYNDALE AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55412-2558
Country	:	US
Telephone Number	:	612-803-5038
Fax Number	:	763-559-7706

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

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	11/01/2021

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