Individual
MARK W. ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
1215 SE 7TH AVE, GRAND RAPIDS, MN 55744-4201
(218) 327-1105
Mailing address
1215 SE 7TH AVE, GRAND RAPIDS, MN 55744-4201
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302045
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1021875
PREFERRED ONE
MN
01
—
8199PNO
BCBS
MS
01
—
84-10374
UBH
MN
Enumeration date
01/23/2008
Last updated
01/23/2008
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