Provider Demographics
NPI:1083777064
Name:DILLARD, ANNA (SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:DILLARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 TRANSIT CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-5142
Mailing Address - Country:US
Mailing Address - Phone:512-736-7780
Mailing Address - Fax:
Practice Address - Street 1:3303 NORTHLAND DR STE 312
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4956
Practice Address - Country:US
Practice Address - Phone:512-291-2669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100810235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100810OtherSLP LICENSE