Provider Demographics
NPI:1790951424
Name:ANDERSON, DRYW C (SW)
Entity Type:Individual
Prefix:
First Name:DRYW
Middle Name:C
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 N US HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0726
Mailing Address - Country:US
Mailing Address - Phone:608-757-5378
Mailing Address - Fax:
Practice Address - Street 1:3506 N US HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0726
Practice Address - Country:US
Practice Address - Phone:608-757-5378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3150-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker