Provider Demographics
NPI:1093941155
Name:ANDERSON, ELWOOD G (EDD)
Entity Type:Individual
Prefix:DR
First Name:ELWOOD
Middle Name:G
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 ROBIN AVE
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1516
Mailing Address - Country:US
Mailing Address - Phone:989-354-8967
Mailing Address - Fax:989-356-6588
Practice Address - Street 1:552 ROBIN AVE
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1516
Practice Address - Country:US
Practice Address - Phone:989-354-8967
Practice Address - Fax:989-356-6588
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIASHA 00003855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist