Provider Demographics
NPI:1124232608
Name:ANDERT, JEFFREY N (PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:N
Last Name:ANDERT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3418
Mailing Address - Country:US
Mailing Address - Phone:269-968-2811
Mailing Address - Fax:269-968-2651
Practice Address - Street 1:7 HERITAGE OAK LN STE 1
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4283
Practice Address - Country:US
Practice Address - Phone:269-968-2811
Practice Address - Fax:269-968-2651
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002295103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent