Jac Anderson

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

14663 Mercantile Dr N
Hugo, MN 55038-4559

Phone

(612) 405-3156

NPI assigned

Jun 16, 2023

Last updated

Jun 16, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Grace Anderson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Autism Services of Minnesota

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hugo, MN
  • NPI 1538820899
  NPD

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

{
    "created_epoch": "1686873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686873600000",
    "number": "1245915388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14663 MERCANTILE DR N",
            "city": "HUGO",
            "state": "MN",
            "postal_code": "550384559",
            "telephone_number": "612-405-3156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14663 MERCANTILE DR N",
            "city": "HUGO",
            "state": "MN",
            "postal_code": "550384559",
            "telephone_number": "612-405-3156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-16",
        "last_updated": "2023-06-16",
        "certification_date": "2023-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRACE",
            "last_name": "ANDERSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Aishat Oluwatosin Adeyemo, DNP APRN AGACNP-BC
• Madeline Maicie Alamo
• Tryniti Nicole Almquist
• Kylie Amon
• Joshua Anderberg, D.C.
• Anna A Annim
• Apollo Homes Incorporated
• Aaron Richard Arvig, D.C.
• Kelsey Helena Asklund
• Associated Eye Care Optical LLC

• Behavior Technician in Hugo, MN
• Providers in Hugo, MN by specialty
• Behavior Technician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.