Individual
JAMIE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAPC
Contact information
Practice address
3401 45TH ST S STE A, FARGO, ND 58104-8970
(013) 564-3847
Mailing address
3401 45TH ST S STE A, FARGO, ND 58104-8970
(701) 356-4384
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
706-12-15-11A
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1462276
—
ND
Enumeration date
01/11/2012
Last updated
04/19/2018
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