Individual
MELISSA JEAN ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
316 ELM AVE, MOOSE LAKE, MN 55767-7706
(218) 485-4445
(218) 485-0477
Mailing address
316 ELM AVE, MOOSE LAKE, MN 55767-7706
(218) 485-4445
(218) 485-0477
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5864
MN
106H00000X
Marriage & Family Therapist
1494
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
094906000
—
MN
Enumeration date
04/21/2006
Last updated
01/23/2024
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