Provider Demographics
NPI:1164281580
Name:ANDERSON, JOANN (MASTER'S DEGREE)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MASTER'S DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-1287
Mailing Address - Country:US
Mailing Address - Phone:507-832-2652
Mailing Address - Fax:507-407-3183
Practice Address - Street 1:2150 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-1287
Practice Address - Country:US
Practice Address - Phone:507-831-0634
Practice Address - Fax:507-407-3183
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist