Individual
DR. JEAN ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4047-A
AS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4047-A
HEALTH REGULATORY BOARD LICENSE
AS
Enumeration date
06/18/2015
Last updated
06/18/2015
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