Individual
JASON ANDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
1015 S BROADWAY STE 18, MINOT, ND 58701-4667
(701) 857-8500
(701) 857-8555
Mailing address
1015 S BROADWAY STE 18, MINOT, ND 58701-4667
(701) 857-8500
(701) 857-8555
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1474
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020518
BCBS ND PIN
ND
05
—
054517
—
ND
Enumeration date
07/02/2006
Last updated
07/08/2007
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