Individual
MR. GREGORY T ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LP
Contact information
Practice address
214 W SUPERIOR ST, SKYWALK LEVEL, DULUTH, MN 55802-1904
(218) 722-2273
(218) 726-1183
Mailing address
1401 EAST FIRST STREET, DULUTH, MN 55805
(218) 728-4491
(218) 728-4404
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
LP1457
MN
1041C0700X
Clinical Social Worker
7341
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024 R1LA
BLUE CROSS/BLUE SHIELD
MN
01
—
1016110
PREFERRED ONE BHP
MN
01
—
106621
U CARE
MN
01
—
46092
OPTUM
MN
01
—
62-21313
MEDICA / UBH
MN
05
—
943752500
—
MN
Enumeration date
08/23/2006
Last updated
05/24/2012
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