Provider Demographics
NPI:1558026062
Name:ANDERSON, ROBERT JOSHUA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSHUA
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 BALSAM TRL E
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1710
Mailing Address - Country:US
Mailing Address - Phone:218-686-8840
Mailing Address - Fax:
Practice Address - Street 1:3514 LYNDALE AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2558
Practice Address - Country:US
Practice Address - Phone:612-803-5038
Practice Address - Fax:763-559-7706
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist