Provider Demographics
NPI:1013224641
Name:BOLSTAD, ANNE (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:BOLSTAD
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:BAR MILLS
Mailing Address - State:ME
Mailing Address - Zip Code:04004-0038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BAR MILLS
Practice Address - State:ME
Practice Address - Zip Code:04004-0001
Practice Address - Country:US
Practice Address - Phone:207-929-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1789235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist