Provider Demographics
NPI:1033968045
Name:ANDERSON, ANNE MARSHALL (MA)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARSHALL
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA
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 703
Mailing Address - Street 2:
Mailing Address - City:PANGUITCH
Mailing Address - State:UT
Mailing Address - Zip Code:84759-0703
Mailing Address - Country:US
Mailing Address - Phone:435-616-5060
Mailing Address - Fax:
Practice Address - Street 1:3922 N MINERSVILLE HWY
Practice Address - Street 2:
Practice Address - City:ENOCH
Practice Address - State:UT
Practice Address - Zip Code:84721-7224
Practice Address - Country:US
Practice Address - Phone:435-267-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health