Basic Information
| Provider Information | |||||||||
| NPI: | 1649744079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 W WORLEY ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652032037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732142314 | ||||||||
| FaxNumber: | 5736072885 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 W WORLEY ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652032037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732142341 | ||||||||
| FaxNumber: | 5736072885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2019 | ||||||||
| LastUpdateDate: | 08/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2019026247 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.