Provider Demographics
NPI:1073542981
Name:ANDERSON, JANE M (PSYCHOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:M
Other - Last Name:IVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2407
Mailing Address - Country:US
Mailing Address - Phone:218-728-4491
Mailing Address - Fax:218-728-4404
Practice Address - Street 1:40 11TH ST
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1817
Practice Address - Country:US
Practice Address - Phone:218-879-4559
Practice Address - Fax:218-879-0282
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2925103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN264327800Medicaid