Provider Demographics
NPI:1013447903
Name:ANDERSON, JEMMALEE ANDIE (BSSW MARS)
Entity Type:Individual
Prefix:
First Name:JEMMALEE
Middle Name:ANDIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BSSW MARS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 HIGHWAY V V
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-0071
Mailing Address - Country:US
Mailing Address - Phone:573-888-6454
Mailing Address - Fax:573-888-2369
Practice Address - Street 1:1109 JONES ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3824
Practice Address - Country:US
Practice Address - Phone:573-888-5925
Practice Address - Fax:573-888-2369
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator