Jennifer L Anderson

Individual provider Active NPI Mental Health Counselor · Dixon, IL

NPI 1306148374 · NPPES record last updated Nov 24, 2010

Key facts

NPI: 1306148374
Entity type: Individual (NPI type 1)
Primary specialty: Mental Health Counselor 101YM0800X
Practice address: 322 Depot Ave
Dixon, IL 61021-2850
Phone: (815) 288-6057
NPI assigned: Nov 24, 2010
Sex: Female
Sole proprietor: Yes

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.

Sinnissippi Centers, Inc. Mental Illness Community Based Residential Treatment Facility · Dixon, IL · NPI 1538447313

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Practice roles

Organization	Specialty	Status	New patients
Sinnissippi Centers, Inc.		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Mental Health Counselor	101YM0800X			Yes

Addresses

Primary practice location

322 Depot Ave
Dixon, IL 61021-2850

Mailing address

424 W 8TH St
Dixon, IL 61021-3622
Phone (815) 994-2686

Other providers in Dixon, IL

All providers in Dixon, IL · Mental Health Counselor in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 24, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.