Provider Demographics
NPI:1801081898
Name:ANDERSON, JEANNINE S
Entity type:Individual
Prefix:MRS
First Name:JEANNINE
Middle Name:S
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JEANNINE
Other - Middle Name:C
Other - Last Name:STOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10200 PARK MEADOWS DR
Mailing Address - Street 2:UNIT 2933
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5456
Mailing Address - Country:US
Mailing Address - Phone:719-930-6334
Mailing Address - Fax:
Practice Address - Street 1:10200 PARK MEADOWS DR
Practice Address - Street 2:UNIT 2933
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5456
Practice Address - Country:US
Practice Address - Phone:719-930-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2008-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health