Provider Demographics
NPI:1275229684
Name:ANDERSON, CHANON CATHERINE
Entity Type:Individual
Prefix:
First Name:CHANON
Middle Name:CATHERINE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SABIN
Mailing Address - State:MN
Mailing Address - Zip Code:56580-4126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 4TH AVE W
Practice Address - Street 2:
Practice Address - City:SABIN
Practice Address - State:MN
Practice Address - Zip Code:56580-4126
Practice Address - Country:US
Practice Address - Phone:701-388-2363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator