Provider Demographics
NPI:1205093994
Name:ANDERSON, NATALIE DIANE (MS, LMFT)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:DIANE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 N ELMHURST RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1729
Mailing Address - Country:US
Mailing Address - Phone:414-795-3578
Mailing Address - Fax:
Practice Address - Street 1:4035 N ELMHURST RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1729
Practice Address - Country:US
Practice Address - Phone:414-795-3578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15-228106H00000X
WI841-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist