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DR. JEAN ANDERSON PSYD

Clinical >> Psychologist >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1366824096

Individual Registrant:
DR. JEAN  ANDERSON PSYD
Gender: F
Sole Proprietor

Location and contact information for practice:
552 FAGAIMA ROAD  PAGO PAGO, AS 96799 US
Tel: 684-252-7455  Fax: --

Contact information for business:
PO BOX 552 FAGAIMA ROAD PAGO PAGO, AS 96799-0552 US
Tel: 684-252-7455  Fax: --

Registration Information:
NPI: 1366824096
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103TC0700XBehavioral Health & Social Service Providers
Psychologist
Clinical
AS4047-A

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
HEALTH REGULATORY BOARD LICENSE4047-AAS01




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