Provider Demographics
NPI:1053017103
Name:ANDERSEN, JENNIFER (MSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1272
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03866-1272
Mailing Address - Country:US
Mailing Address - Phone:603-841-5353
Mailing Address - Fax:603-841-5355
Practice Address - Street 1:326 ROCHESTER HILL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-1700
Practice Address - Country:US
Practice Address - Phone:603-948-1230
Practice Address - Fax:603-948-1098
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator