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DENNIS J ANDERSON LCSW CADCIII

Addiction Substance Use Disorder

Port Washington, Wisconsin

Provider NPI: 1265479257

Provider Information:
 DENNIS J ANDERSON LCSW CADCIII
Gender: M
Not Sole Proprietor

Practice Location:
1317 W GRAND AVE  PORT WASHINGTON, WI 53074 US
Tel: 262-284-5789  Fax: 262-284-5907

Business Mailing Address:
1317 W GRAND AVE  PORT WASHINGTON, WI 53074 US
Tel: 262-284-5789  Fax: 262-284-5907

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
WI2249
Y1041C0700XBehavioral Health & Social Service Providers
Social Worker
WI3072-123

Other Provider Identifiers:

IssuerNumberStateType
39730700WI05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







ADDICTION JOBS WI - Page 1

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