Kelly Janine Anderson, SUDRC I #24481

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

MPSSQTUFZB Issued in CA

Practice address

161 N Date St
Escondido, CA 92025-3405

Phone

(760) 291-4788

NPI assigned

Sep 11, 2026

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1789084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789084800000",
    "number": "1104736990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24934 ABALAR WAY",
            "city": "RAMONA",
            "state": "CA",
            "postal_code": "920654649",
            "telephone_number": "855-740-2487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 N DATE ST",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253405",
            "telephone_number": "760-291-4788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KELLY",
        "middle_name": "JANINE",
        "name_prefix": "Ms.",
        "credential": "SUDRC I #24481",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-09-11",
        "last_updated": "2026-09-11",
        "certification_date": "2026-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "24481",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": "RBT262840842",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "CA",
            "license": "MPSSQTUFZB",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEER SPECIALIZATION IN IN-CRISIS CARE - CALMHSA CERTIFIED",
            "identifier": "NONNUMERIC",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JUSTICE-INVOLVED PEER SPECIALIZATION - CALMHSA CERTIFIED",
            "identifier": "NONNUMERIC",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MPSS-QTUFZB",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERED BEHAVIOR TECHNICIAN THROUGH BACB LICENSURE",
            "identifier": "BACB1530984",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL PEER RECOVERY SUPPORT SPECIALIST THROUGH NAADAC CERTIFICATION",
            "identifier": "NONNUMERIC",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEER SPECIALIZATION IN PARENTS FAMILY MEMBERS AND CAREGIVERS CALMHSA CERTIFIED",
            "identifier": "NONNUMERIC",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alani Anderson
• Catherine Lynn Anderson, RPH
• Charlene Mary Anderson
• Gillian Anderson
• Isabella Anderson
• Nancy Jean Anderson
• Rob Anderson
• Wilma Gail Anderson, MS, CRC
• Melissa Andrade Lopez
• Ileana Andrade

• Peer Specialist in Escondido, CA
• Providers in Escondido, CA by specialty
• Peer Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.