Provider Demographics
NPI:1568058766
Name:ANDERSON, JENNIFER (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:LAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:10486 E QUEENS WREATH LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8575
Mailing Address - Country:US
Mailing Address - Phone:480-313-8896
Mailing Address - Fax:
Practice Address - Street 1:10486 E QUEENS WREATH LN
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-8575
Practice Address - Country:US
Practice Address - Phone:480-313-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health