Provider Demographics
NPI:1285729525
Name:ANDERSEN, ARLOW (BILL) WILLIAM (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:ARLOW (BILL)
Middle Name:WILLIAM
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440
Mailing Address - Country:US
Mailing Address - Phone:612-262-4813
Mailing Address - Fax:612-262-4194
Practice Address - Street 1:1110 YANKEE DOODLE ROAD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121
Practice Address - Country:US
Practice Address - Phone:651-454-3970
Practice Address - Fax:651-241-0059
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2177103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN148M5ANOtherBCBSMN INDIV. PROVIDER NO
MN272553300Medicaid
MN148M5ANOtherBCBSMN INDIV. PROVIDER NO