Provider Demographics
NPI:1114650603
Name:NELSON, ANNE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:RODEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6061 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-1897
Mailing Address - Country:US
Mailing Address - Phone:609-335-4224
Mailing Address - Fax:
Practice Address - Street 1:6061 MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-1897
Practice Address - Country:US
Practice Address - Phone:609-335-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-03
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01138200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist