Active NPI
Eric M Anderson, PHD
- Psychologist
- Wausau, WI
National Provider Identifier
1205906179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1994-057
- Practice address
- 516 McClellan Street
Wausau, WI 54403-4844 - Phone
- (715) 834-2046
- Fax
- (715) 834-7563
- NPI assigned
- Nov 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1994-057 | WI | Primary |
Addresses
Primary practice location
516 McClellan Street
Wausau, WI 54403-4844
Mailing address
1320 W Clairemont Ave
Suite 200
Eau Claire, WI 54701
Phone (715) 842-5577
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39713500 | Medicaid | WI | |
| 44426 | Other | WI | NATIONAL REGISTER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1994-057 | WI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lutheran Social Services of Wisconsin and Upper Michigan, Inc. | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba LSS Janesville Clinic
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Janesville, WI
- NPI 1386719177
Psychologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205906179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1320 W CLAIREMONT AVE",
"address_2": "SUITE 200",
"city": "EAU CLAIRE",
"state": "WI",
"postal_code": "54701",
"telephone_number": "715-842-5577",
"fax_number": "715-845-8483"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 MCCLELLAN STREET",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544034844",
"telephone_number": "715-834-2046",
"fax_number": "715-834-7563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "ERIC",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "1994-057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39713500",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL REGISTER",
"identifier": "44426",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wausau, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.