Provider Demographics
NPI:1871399659
Name:ANDERSON, TARYN (LAC)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15226 W FREEWAY DR NE
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-9433
Mailing Address - Country:US
Mailing Address - Phone:651-464-7111
Mailing Address - Fax:
Practice Address - Street 1:15226 W FREEWAY DR NE
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-9433
Practice Address - Country:US
Practice Address - Phone:651-464-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1762171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist