MEDICARE: JOHN RUSSELL ANDERSON MSW LCSW

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	1041C0700X	Clinical Social Worker	984043	CO

General Provider Information

NPI Number	:	1962605766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN RUSSELL ANDERSON MSW LCSW

Provider Business Mailing Address
First Line	:	5419 MORNING GLORY LANE
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80123-2944
Country	:	US
Telephone Number	:	303-797-7407
Fax Number	:

Provider Business Practice Location Address
First Line	:	3190 SO WADSWORTH BLVD
Second Line	:	SUITE #370
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-4807
Country	:	US
Telephone Number	:	303-987-3284
Fax Number	:	303-986-2518

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

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	07/08/2007

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