Individual
KEVIN SCOTT ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.S., LP
Contact information
Practice address
111 N MAIN ST STE 205, AUSTIN, MN 55912-3474
(507) 440-0134
(855) 748-3132
Mailing address
1914 12TH AVE NE, AUSTIN, MN 55912-4009
(507) 440-0134
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP3823
MN
103TS0200X
School Psychologist
LP3823
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38734400
—
MN
Enumeration date
03/30/2015
Last updated
03/17/2018
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