JACK DAVID ANDERSON
NPI 1023712882
Marriage & Family Therapist in Maple Grove, MN

Q: What is Jack Anderson's NPI number?

The NPI number for Jack Anderson is 1023712882. It was assigned to this individual provider in the NPPES registry on March 27, 2023.

Q: What is Jack Anderson's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Q: When was this NPI record last updated?

The NPPES record for Jack Anderson was last updated on March 27, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 27, 2023PECOS Enrolled

10900 89TH AVE N STE 3, MAPLE GROVE, MN 55369(651) 560-0050 Get Directions Write a Review

NPPES record last updated: March 27, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Jack David Anderson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACK DAVID ANDERSON (NPI 1023712882) is an individual marriage & family therapist in Maple Grove, Minnesota and active in the NPI registry since March 2023. He is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1023712882

Entity TypeIndividualMale

Primary Taxonomy106H00000X

Provider Legal NameJACK DAVID ANDERSON

Location Address10900 89TH AVE N STE 3Maple Grove, MN 55369-4025

Mailing Address13060 N 3rd Ave Apt 1bLindstrom, MN 55045-7322

Phone(651) 560-0050

Sole ProprietorNo

Medical School CMSOtherGraduated 2023

Enumeration DateMarch 27, 2023

NPPES CertifiedMarch 27, 2023

✔ NPI 1023712882 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers

Taxonomy Code106H00000X

Definition

A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.

10900 89TH AVE N STE 3, Maple Grove, MN 55369

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jack David Anderson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5991291841

PECOS Enrollment IDI20251231000749

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MIKAYLA L CHRISTIANSON MA, LPCC

Counselor (Mental Health)

10900 89TH AVE N STE 3
MAPLE GROVE, MN 55369

Hennepin County (651) 560-0050

SARAH NICOLE RIMA LPCC

Counselor (Mental Health)

10900 89TH AVE N STE 3
MAPLE GROVE, MN 55369

Hennepin County (651) 560-0050

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Anderson's NPI number?

The NPI number for Jack Anderson is 1023712882. It was assigned to this individual provider in the NPPES registry on March 27, 2023.

Where is Jack Anderson located?

Jack Anderson practices at 10900 89th Ave N Ste 3, Maple Grove, MN 55369. The listed phone number is (651) 560-0050.

What is Jack Anderson's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Is Jack Anderson enrolled in Medicare?

Yes. Jack Anderson is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jack Anderson was last updated on March 27, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.