Basic Information
| Provider Information | |||||||||
| NPI: | 1003388398 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSEN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 817 MAIN ST N | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550081275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7633070610 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 701 DELLWOOD ST S | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550081920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7636898700 | ||||||||
| FaxNumber: | 7636887941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2018 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CC0219 | MN | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 2019 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.