Provider Demographics
NPI:1265075436
Name:ANDERSON, KASANDRA JO (LPC)
Entity type:Individual
Prefix:MS
First Name:KASANDRA
Middle Name:JO
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 ALBION AVE
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318
Mailing Address - Country:US
Mailing Address - Phone:208-878-9178
Mailing Address - Fax:208-878-9179
Practice Address - Street 1:1305 ALBION AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318
Practice Address - Country:US
Practice Address - Phone:208-878-9178
Practice Address - Fax:208-878-9179
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker