Provider Demographics
NPI:1730467242
Name:ANDERSON, JOELLENE (LCSW)
Entity Type:Individual
Prefix:
First Name:JOELLENE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9108 GLORALEE ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-5137
Mailing Address - Country:US
Mailing Address - Phone:907-602-3294
Mailing Address - Fax:
Practice Address - Street 1:9108 GLORALEE ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-5137
Practice Address - Country:US
Practice Address - Phone:907-602-3294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK13501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
452816007OtherUNITED HEALTHCARE
842880OtherODS
A02TT9A02V43OtherPREMERA BLUE CROSS BLUE SHIELD OF ALASKA
9717968OtherAETNA