MEDICARE: REBECCA MICHELLE ANDERSON LPCC, LADC

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	171400000X	Health & Wellness Coach
2	101YP2500X	Professional Counselor	3283	MN

General Provider Information

NPI Number	:	1639814783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA MICHELLE ANDERSON LPCC, LADC

Provider Business Mailing Address
First Line	:	8808 373RD AVE NW
Second Line	:
City	:	PRINCETON
State	:	MN
Zip	:	55371-5512
Country	:	US
Telephone Number	:	651-210-4020
Fax Number	:

Provider Business Practice Location Address
First Line	:	716 FREEPORT AVE NW
Second Line	:
City	:	ELK RIVER
State	:	MN
Zip	:	55330-2645
Country	:	US
Telephone Number	:	219-595-2121
Fax Number	:

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

Provider Enumeration Date	:	05/03/2022
Last Update Date	:	03/22/2024

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