Provider Demographics
NPI:1417023508
Name:ANDERSON, JARILYN MARIE (MA)
Entity Type:Individual
Prefix:
First Name:JARILYN
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 113TH AVE NW
Mailing Address - Street 2:APT. 112
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-7412
Mailing Address - Country:US
Mailing Address - Phone:763-242-1352
Mailing Address - Fax:
Practice Address - Street 1:1701 113TH AVE NW
Practice Address - Street 2:APT. 112
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55433-7412
Practice Address - Country:US
Practice Address - Phone:763-242-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health