Individual
JENNIFER C ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-7700
(440) 684-5829
Mailing address
3605 WARRENSVILLE CENTER RD, SHAKER HTS, OH 44122-5203
(440) 684-5816
(440) 684-5952
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6171
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000385549
ANTHEM
OH
05
—
2624244
—
OH
Enumeration date
04/03/2007
Last updated
07/08/2007
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