Jack David Anderson
NPI 1023712882ActiveIndividual· Marriage & Family Therapist· Maple Grove, MN
Marriage & Family Therapist in Maple Grove, Minnesota, with an NPI issued in March 2023. Enrolled in Medicare as practitioner - marriage and family therapist.
Overview
| NPI | 1023712882 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | No |
| NPI issued | Mar 27, 2023 |
| Last updated in NPPES | Mar 27, 2023 |
| Certified by provider | Mar 27, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Marriage & Family Therapist Primary | 106H00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Marriage and Family Therapist (MN) |
|---|
Education and affiliations
| Graduation year | 2023 |
|---|---|
| Medicare specialty | Marriage And Family Therapist |
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