Individual
JACOB ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LLC
Contact information
Practice address
4439 BUTTERNUT ST, CLARKSTON, MI 48348-1312
(248) 690-5286
Mailing address
4439 BUTTERNUT ST, CLARKSTON, MI 48348-1312
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6451022424
MI
101Y00000X
Counselor
C.2103322-TRNE
OH
Other
Enumeration date
08/16/2021
Last updated
01/06/2025
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