Provider Demographics
NPI:1053457390
Name:PRUNTY, ANNA MAIRE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MAIRE
Last Name:PRUNTY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5913
Mailing Address - Country:US
Mailing Address - Phone:516-297-7858
Mailing Address - Fax:
Practice Address - Street 1:635 HICKORY ST
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5913
Practice Address - Country:US
Practice Address - Phone:516-297-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013878235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist