Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jack David Anderson

Individual provider Marriage & Family Therapist · NPI 1023712882

Jack David Anderson is a Marriage and Family Therapist in Maple Grove, Minnesota. Qualified in 2023, 3 years ago. Registered with an NPI since 2023.

Years since qualifying
3
In the registry since
2023

Practice location Address checks out

10900 89th Ave N Ste 3
Maple Grove, MN 55369-4025
Phone: (651) 560-0050
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Marriage & Family Therapist (primary) Taxonomy 106H00000X

Record details

NPI number1023712882
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 27, 2023
Last updated in NPPESMarch 27, 2023
Certification dateMarch 27, 2023
Mailing address13060 N 3rd Ave Apt 1b, Lindstrom, MN 55045-7322

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMARRIAGE AND FAMILY THERAPIST
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

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