Individual
DENNIS J ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW CADCIII
Contact information
Practice address
1317 W GRAND AVE, PORT WASHINGTON, WI 53074-2075
(262) 284-5789
(262) 284-5907
Mailing address
1317 W GRAND AVE, PORT WASHINGTON, WI 53074-2075
(262) 284-5789
(262) 284-5907
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
2249
WI
1041C0700X
Clinical Social Worker
Primary
3072-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39730700
—
WI
Enumeration date
05/31/2006
Last updated
10/18/2007
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