| Doctor Name: | MR. JEFFREY D. ANDERSON |
| NPI Number: | 1063684421 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS, CCC-SLP |
| License Number: | SLP-1119 |
| Business Practice Address: | 393 E 2nd N Rexburg, ID - 83440 |
| Business Phone Number: | 2083599570 |
| Business Fax Number: | 2083599580 |
| Mailing Address: | 393 E 2nd N, REXBURG |
| State: | ID |
| Postal Code: | 83440 |
| Phone Number: | 2083599570 |
| Fax Number: | 2083599580 |
| NPI Enumeration Date: | 03/26/2008 |
| NPI Last Update Date: | 09/01/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SLP-1119 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |