Provider Demographics
NPI:1154455848
Name:LANDES, ANNETTE LYNN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:LYNN
Last Name:LANDES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7888 KREMERS LN
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:CO
Mailing Address - Zip Code:80535-9580
Mailing Address - Country:US
Mailing Address - Phone:970-217-9532
Mailing Address - Fax:970-568-0705
Practice Address - Street 1:7888 KREMERS LN
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:CO
Practice Address - Zip Code:80535-9580
Practice Address - Country:US
Practice Address - Phone:970-217-9532
Practice Address - Fax:970-568-0705
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0191121235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63900262Medicaid