Provider Demographics
NPI:1104832237
Name:WALTON, ANNE MARIE (MA CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:MARIE
Last Name:WALTON
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:BRABEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC SLP
Mailing Address - Street 1:PO BOX 1764
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740
Mailing Address - Country:US
Mailing Address - Phone:505-447-0399
Mailing Address - Fax:
Practice Address - Street 1:101 NORTH SECOND ST
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740
Practice Address - Country:US
Practice Address - Phone:505-445-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2989235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM46157549Medicaid