Provider Demographics
NPI:1700079183
Name:ANDERSON, JANICE (AU D)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CLEBURNE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-4435
Mailing Address - Country:US
Mailing Address - Phone:540-674-4889
Mailing Address - Fax:540-674-1666
Practice Address - Street 1:85 CLEBURNE BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-4435
Practice Address - Country:US
Practice Address - Phone:540-674-4889
Practice Address - Fax:540-674-1666
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
380784OtherANTHEM
VA009451447Medicaid