| Doctor Name: | EMILY ANDERSON |
| NPI Number: | 1407953888 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LAT |
| License Number: | 698-039 |
| Business Practice Address: | 1100 Gateway Ct West Bend, WI - 53095 |
| Business Phone Number: | 2623066100 |
| Business Fax Number: | 2623066105 |
| Mailing Address: | N169w20217 Wilshire Dr, JACKSON |
| State: | WI |
| Postal Code: | 530379409 |
| Phone Number: | 2625735333 |
| Fax Number: | 2623063105 |
| NPI Enumeration Date: | 09/20/2006 |
| NPI Last Update Date: | 06/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 698-039 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |