Provider Demographics
NPI:1245505932
Name:ANDERSEN, EMILY ANN (MSW, LMSW)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ANN
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8779 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-9753
Mailing Address - Country:US
Mailing Address - Phone:616-997-2410
Mailing Address - Fax:
Practice Address - Street 1:654 DAVIS AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-5149
Practice Address - Country:US
Practice Address - Phone:616-897-7842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801090629104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker