Individual
MARY LU ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, RN, CSAC
Contact information
Practice address
5013 E BUCKEYE RD, MADISON, WI 53716-2301
(608) 222-8654
Mailing address
5013 E BUCKEYE RD, MADISON, WI 53716-2301
(608) 222-8654
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1911-132
WI
101YM0800X
Mental Health Counselor
Primary
973-123
WI
163W00000X
Registered Nurse
41435-030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39295500
—
WI
Enumeration date
12/07/2007
Last updated
12/07/2007
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