Provider Demographics
NPI:1306583091
Name:ANDERSEN, DEMI C (MHP)
Entity type:Individual
Prefix:
First Name:DEMI
Middle Name:C
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60073-3060
Mailing Address - Country:US
Mailing Address - Phone:224-201-1530
Mailing Address - Fax:
Practice Address - Street 1:1790 NATIONS DR STE 101-110
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9164
Practice Address - Country:US
Practice Address - Phone:224-201-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health