| Doctor Name: | MR. JEROME ANDERSON |
| NPI Number: | 1023435807 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW, LCSW, CMFSW |
| License Number: | 2011009028 |
| Business Practice Address: | 1719 Coupru Ct Saint Peters, MO - 633764558 |
| Business Phone Number: | 3146514014 |
| Business Fax Number: | |
| Mailing Address: | 1719 Coupru Ct, SAINT PETERS |
| State: | MO |
| Postal Code: | 633764558 |
| Phone Number: | 3146514014 |
| Fax Number: | |
| NPI Enumeration Date: | 03/18/2014 |
| NPI Last Update Date: | 04/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 2011009028 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |