1508585563 NPI number — MRS. ANNE HOLLOWAY BOHANNON M.S. CCC-SLP

Table of content: MRS. ANNE HOLLOWAY BOHANNON M.S. CCC-SLP (NPI 1508585563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508585563 NPI number — MRS. ANNE HOLLOWAY BOHANNON M.S. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOHANNON
Provider First Name:
ANNE
Provider Middle Name:
HOLLOWAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHWARTZ
Provider Other First Name:
ANNE
Provider Other Middle Name:
HOLLOWAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S. CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508585563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4913 OAKS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45042-4921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-816-1190
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4913 OAKS CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45042-4921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-816-1190
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  11597 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11597 . This is a "OHIO SPEECH AND HEARING PROFESSIONALS BOARD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 14051394 . This is a "ASHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: OH3228036 . This is a "OHIO DEPARTMENT OF EDUCATION PUPIL SERVICES LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".