Provider Demographics
NPI:1992808844
Name:ANDERSON, JANET MARIE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:MARIE
Other - Last Name:HENGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:5048 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1125
Mailing Address - Country:US
Mailing Address - Phone:612-702-3706
Mailing Address - Fax:
Practice Address - Street 1:529 W. COUNTY ROAD E
Practice Address - Street 2:SUITE C
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-1125
Practice Address - Country:US
Practice Address - Phone:651-287-6022
Practice Address - Fax:651-486-3954
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15441104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP49680OtherHEALTHPARTNERS
MN405L6HEOtherBCBS
MNHP49680OtherHEALTHPARTNERS