Provider Demographics
NPI:1578284915
Name:ANDERSON, EMILY KAITLIN (MS, CGC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KAITLIN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 S GRAYSTONE AVE UNIT 7
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8576
Mailing Address - Country:US
Mailing Address - Phone:303-507-5203
Mailing Address - Fax:
Practice Address - Street 1:801 BROADWAY AVE NW STE 203
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4463
Practice Address - Country:US
Practice Address - Phone:855-776-9436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS