Provider Demographics
NPI:1083848576
Name:LIBERA, ANN K (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:K
Last Name:LIBERA
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 1:805 S CROUSE AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13244-0001
Mailing Address - Country:US
Mailing Address - Phone:315-443-5761
Mailing Address - Fax:315-443-4413
Practice Address - Street 1:805 S CROUSE AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13244-0001
Practice Address - Country:US
Practice Address - Phone:315-443-5761
Practice Address - Fax:315-443-4413
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58009531235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist