DR. JACK GLENN ANDERSON (NPI# 1134330947) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134330947 |
| Entity Type | Individual |
| Full Name | DR. JACK GLENN ANDERSON |
| Credential | PH.D. |
| Practice Address |
200 E Del Mar Blvd Suite 122 Pasadena CA 91105-2544 |
| Practice Telephone | 6267928922 |
| Practice Fax Number | 6267926504 |
| Mailing Telephone | 6267928922 |
| Mailing Fax Number | 6267926504 |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
PSY10819 | CA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982254603 | Jack Anderson | Technician | 14810 La Mesa Rd, Victorville, CA 92392-8639 | 2019-09-14 |
| 1154523470 | Jack Anderson | Chiropractor | 226 E 29th St Unit B, Loveland, CO 80538-2825 | 2007-05-31 |
| 1659338887 | Jack Anderson | Emergency Medicine | 9787 N 91st St Ste 101, Scottsdale, AZ 85258-5088 | 2006-05-01 |
| 1881166775 | Jack Raymond Anderson | Surgery | 1730 W 25th St, Cleveland, OH 44113-3108 | 2018-12-18 |
| 1245527969 | Jack D Anderson | Family Medicine | 1515 Edmonton Rd, Tompkinsville, KY 42167-9402 | 2011-07-01 |
| 1609948223 | Jack Martin Anderson | Pediatrics | 3003 Health Center Dr, San Diego, CA 92123-2700 | 2006-11-15 |
| 1417976234 | Jack D Anderson | Pediatrics | 7030 Pineville Matthews Rd, Charlotte, NC 28226-8298 | 2006-07-19 |
| 1992737522 | Jack Anderson | Internal Medicine | 2500 E Capitol Dr, Appleton, WI 54911-8735 | 2006-07-06 |
| 1811964000 | Jack W. Anderson | Anesthesiology | 470 Taylor Rd, Montgomery, AL 36117-3563 | 2006-03-07 |
| Street Address |
200 E DEL MAR BLVD SUITE 122 |
| City | PASADENA |
| State | CA |
| Zip Code | 91105-2544 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578537908 | Louise Seto Lew Nagahori | Physical Therapy Assistant | 200 E Del Mar Blvd, #302, Pasadena, CA 91105-2544 | 2006-02-14 |
| 1205367158 | Carley Ann Wade | Occupational Therapist | 200 E Del Mar Blvd, Suite 112, Pasadena, CA 91105-2544 | 2017-03-22 |
| 1104378652 | Kaylee Kono | Occupational Therapist | 200 E Del Mar Blvd, Suite 112, Pasadena, CA 91105-2544 | 2016-11-01 |
| 1104376011 | Jane Cunha | Counselor | 200 E Del Mar Blvd, Suite 119, Pasadena, CA 91105-2544 | 2016-10-04 |
| 1437604220 | Ashley Sepeedeh Sohrab | Speech-Language Pathologist | 200 E Del Mar Blvd, Pasadena, CA 91105-2544 | 2016-08-22 |
| 1073965885 | Hanna Bogen | Speech-Language Pathologist | 200 E Del Mar Blvd, Suite 112, Pasadena, CA 91105-2544 | 2016-07-05 |
| 1093162208 | Carly Noelle Sanders | Occupational Therapist | 200 E Del Mar Blvd, Suite 112, Pasadena, CA 91105-2544 | 2016-05-17 |
| 1710357876 | Caitlin Ito | Occupational Therapist | 200 E Del Mar Blvd, #112, Pasadena, CA 91105-2544 | 2015-10-01 |
| 1891164299 | Elizabeth Blake Ballance | Physical Therapist | 200 E Del Mar Blvd, Suite 112, Pasadena, CA 91105-2544 | 2015-09-16 |
| 1902299704 | Gigi Jordan | Occupational Therapist | 200 E Del Mar Blvd, Pasadena, CA 91105-2544 | 2015-03-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619451697 | Tonya Michlin | Registered Nurse | 800 Fairmount Ave Ste 110, Pasadena, CA 91105 | 2018-09-17 |
| 1639674161 | David Marcus Md, Inc. | Psychiatry & Neurology | 107 S. Fair Oaks Avenue, Suite #315, Pasadena, CA 91105 | 2018-03-27 |
| 1548778541 | Elias & Jun Dental Corp | Dentist | 301 S. Fair Oaks Ave., Ste 107, Pasadena, CA 91105 | 2018-01-12 |
| 1013429745 | Whitney Catalano | Dietitian, Registered | 100 S Orange Grove Blvd, 103, Pasadena, CA 91105 | 2017-11-03 |
| 1518485630 | Marlon O Miller | Counselor | 1020 South Arroyo Parkway, Pasadena, CA 91105 | 2017-09-08 |
| 1316469976 | Alexandra Scott | Speech-Language Pathologist | 235 La Vereda Road, Pasadena, CA 91105 | 2017-07-14 |
| 1346770443 | Amanda Grace Gentz | Rehabilitation Practitioner | 210 S De Lacey, Ste 110, Pasadena, CA 91105 | 2017-06-13 |
| 1427598390 | Melina Gomez Loza | Licensed Vocational Nurse | 66 Hilburt St #2, Pasadena, CA 91105 | 2017-02-27 |
| 1588115281 | Ramon Banuelos | Rehabilitation Practitioner | 210 S. Delacey Ave Suite 110, Pasadena, CA 91105 | 2016-10-18 |
| 1922554245 | Daniel Joseph Ybarra | Student in an Organized Health Care Education/Training Program | 100 W. California Blvd. Pasadena, Ca 91105, Pasadena, CA 91105 | 2016-08-28 |
| Find all providers in zip 91105 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801401260 | James Chavers Jr. | Psychologist | 335 Cherry Dr, Pasadena, CA 91105-2150 | 2020-09-12 |
| 1801416847 | Insight Personal and Family Therapy, Inc | Psychologist | 65 N Madison Ave Ste 601, Pasadena, CA 91101-2047 | 2020-04-20 |
| 1780222059 | Nevena Mojsilovic | Psychologist | 107 S Fair Oaks Ave Ste 223229, Pasadena, CA 91105-2010 | 2019-12-17 |
| 1366009060 | Hathaway Sycamores Child and Family Services | Psychologist | 2101 E Washington Blvd, Pasadena, CA 91104-1825 | 2019-05-29 |
| 1417514209 | Hathaway Sycamores Child and Family Services | Psychologist | 515 E Ashtabula St, Pasadena, CA 91104-4306 | 2019-05-28 |
| 1447817010 | Samantha Miller | Psychologist | 107 S Fair Oaks Ave Ste 219, Pasadena, CA 91105-2082 | 2019-05-20 |
| 1639533029 | Biljana Bujko | Psychologist | 745 S Marengo Ave Ste 202, Pasadena, CA 91106-4739 | 2016-04-11 |
| 1477919454 | Armine Melkonyan | Psychologist | 595 E Colorado Blvd Ste 409, Pasadena, CA 91101-2018 | 2016-01-07 |
| 1073982344 | Safe Harbor Christian Counseling of Annapolis | Psychologist | 206 Pleasantview Ave, Pasadena, MD 21122-4042 | 2015-09-17 |
| 1861869489 | Supatra Hanna Tovar | Psychologist | 1000 E Walnut St Ste 246, Pasadena, CA 91106-5370 | 2015-08-31 |
| Find all providers in PASADENA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.