Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | CC00801 | MN |
NPI | 1003214156 |
---|---|
Provider Name | Yvette Anderson |
First Address | Moose Lake, MN 55767-9213 |
Second Address | Saint Paul, MN 55114-1489 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2014 |
Last Update Date | 05/12/2014 |