| Doctor Name: | MARY ELLEN ANDERSON |
| NPI Number: | 1255636759 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 246 Industrial Blvd Shell Lake, WI - 548718889 |
| Business Phone Number: | 7154682841 |
| Business Fax Number: | |
| Mailing Address: | 1352 310th Ave, FREDERIC |
| State: | WI |
| Postal Code: | 548374519 |
| Phone Number: | 7154162806 |
| Fax Number: | |
| NPI Enumeration Date: | 01/14/2011 |
| NPI Last Update Date: | 01/14/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |