Provider Demographics
NPI:1306904818
Name:ANDERSON, JANIS D (MA)
Entity type:Individual
Prefix:MS
First Name:JANIS
Middle Name:D
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:JANIS
Other - Middle Name:DA
Other - Last Name:HOGLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:645 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573-1101
Mailing Address - Country:US
Mailing Address - Phone:218-346-5384
Mailing Address - Fax:
Practice Address - Street 1:314 CHARLES ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3208
Practice Address - Country:US
Practice Address - Phone:218-855-1247
Practice Address - Fax:218-855-1248
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5118231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN12D08HEOtherBLUE CROSS BLUE SHIELD
411945552OtherFEDERAL ID
MN4500073OtherMEDICA
MN12D08HEOtherBLUE PLUS
MN7314680-00Medicaid
MN18DO8HEOtherBCBS DME
MN4308814OtherSTATE ID
MN640003703OtherMEDICARE RAILROAD
MN4308814OtherSTATE ID
MN12D08HEOtherBLUE CROSS BLUE SHIELD