Provider Demographics
NPI:1225421449
Name:ANDERSON, KIKI (MS)
Entity Type:Individual
Prefix:
First Name:KIKI
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2131
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34220-2131
Mailing Address - Country:US
Mailing Address - Phone:941-565-6473
Mailing Address - Fax:877-308-4506
Practice Address - Street 1:501 12TH ST W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-3824
Practice Address - Country:US
Practice Address - Phone:941-565-6473
Practice Address - Fax:877-308-4506
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health