MEDICARE: SCOTT 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1912022690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT ANDERSON

Provider Business Mailing Address
First Line	:	975 WINDGATE ST S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-5638
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	182 SW ACADEMY ST
Second Line	:
City	:	DALLAS
State	:	OR
Zip	:	97338-1922
Country	:	US
Telephone Number	:	503-623-9289
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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Directions to “ SCOTT ANDERSON ” Practice Location

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