Provider Demographics
NPI:1316160385
Name:ANDERSON, WILLIAM J P (CSAC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J P
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28141 ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:WI
Mailing Address - Zip Code:54830-8205
Mailing Address - Country:US
Mailing Address - Phone:715-866-8949
Mailing Address - Fax:
Practice Address - Street 1:100 POLK COUNTY PLZ
Practice Address - Street 2:SUITE 50
Practice Address - City:BALSAM LAKE
Practice Address - State:WI
Practice Address - Zip Code:54810-9071
Practice Address - Country:US
Practice Address - Phone:715-485-8862
Practice Address - Fax:715-485-8490
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1255 132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39344200Medicaid
WI663731049156OtherPREFERRED ONE INSURANCE