Provider Demographics
NPI:1083038525
Name:WELLER, ANNA G (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:G
Last Name:WELLER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:101 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-4222
Mailing Address - Country:US
Mailing Address - Phone:504-828-7696
Mailing Address - Fax:
Practice Address - Street 1:101 RIVER RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-4222
Practice Address - Country:US
Practice Address - Phone:504-828-7696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7064235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist