Provider Demographics
NPI:1437946654
Name:ANDERSON, KOURTNEY (MS)
Entity type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:DR
Other - First Name:KOURTNEY
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:N94W15802 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-1534
Mailing Address - Country:US
Mailing Address - Phone:262-299-6604
Mailing Address - Fax:262-299-9792
Practice Address - Street 1:5850 MACKLIND AVE # 1229
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-3569
Practice Address - Country:US
Practice Address - Phone:262-299-6604
Practice Address - Fax:262-299-9792
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional