| Doctor Name: | MRS. JACQUELINE ANNE ANDERSON |
| NPI Number: | 1346397338 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ED.S, LMHP, LPC, |
| License Number: | 2756 |
| Business Practice Address: | 408 10th St Gothenburg, NE - 691381922 |
| Business Phone Number: | 3085290821 |
| Business Fax Number: | |
| Mailing Address: | Rr 1 Box 99, GOTHENBURG |
| State: | NE |
| Postal Code: | 691389607 |
| Phone Number: | 3085372585 |
| Fax Number: | 3085372585 |
| NPI Enumeration Date: | 01/04/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 2756 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | NE |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |