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NPI Code Detail

MEDICARE: JENNIFER ANDERSON M.S., CCC-SLP

MEDICARE: JENNIFER ANDERSON M.S., 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
1235Z00000XSpeech-Language Pathologist0763LMD
2235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1669895173
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ANDERSON M.S., CCC-SLP
Provider Business Mailing Address
First Line : 6625 LYNDALE AVE S STE 430
Second Line :
City : RICHFIELD
State : MN
Zip : 55423-2300
Country : US
Telephone Number : 952-285-2840
Fax Number : 952-285-2830
Provider Business Practice Location Address
First Line : 6625 LYNDALE AVE S STE 430
Second Line :
City : RICHFIELD
State : MN
Zip : 55423-2300
Country : US
Telephone Number : 952-285-2840
Fax Number : 952-285-2830
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2014
Last Update Date : 07/09/2021

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Directions to “ JENNIFER ANDERSON M.S., CCC-SLP” Practice Location

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