Individual
MS. TAVIA LYNNE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2400 W 102ND ST APT 101, BLOOMINGTON, MN 55431-3359
(612) 203-4535
(952) 217-4427
Mailing address
2400 W 102ND ST APT 101, BLOOMINGTON, MN 55431-3359
(612) 203-4535
(952) 217-4427
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
—
—
104100000X
Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
—
—
172A00000X
Driver
Primary
J430163453007
MN
251E00000X
Home Health Agency
—
—
Other
Enumeration date
01/05/2015
Last updated
03/17/2021
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