Provider Demographics
NPI:1083262034
Name:FILIPPONE, ANNA LISE (MT-BC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LISE
Last Name:FILIPPONE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W BLUFF AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6950
Mailing Address - Country:US
Mailing Address - Phone:703-477-2273
Mailing Address - Fax:
Practice Address - Street 1:209 W BLUFF AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-6950
Practice Address - Country:US
Practice Address - Phone:703-477-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA15195225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist