Provider Demographics
NPI:1205906179
Name:ANDERSON, ERIC M (PHD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W CLAIREMONT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-842-5577
Mailing Address - Fax:715-845-8483
Practice Address - Street 1:516 MCCLELLAN STREET
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4844
Practice Address - Country:US
Practice Address - Phone:715-834-2046
Practice Address - Fax:715-834-7563
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1994-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39713500Medicaid
WI44426OtherNATIONAL REGISTER
WI84495010Medicare ID - Type Unspecified