Provider Demographics
NPI:1194860346
Name:GANTRY DOTSON, ANITA R (MS SLP A CCC)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:R
Last Name:GANTRY DOTSON
Suffix:
Gender:F
Credentials:MS SLP A CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 N NATIONAL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532
Mailing Address - Country:US
Mailing Address - Phone:360-740-8992
Mailing Address - Fax:360-740-8993
Practice Address - Street 1:1570 N NATIONAL
Practice Address - Street 2:SUITE 101
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532
Practice Address - Country:US
Practice Address - Phone:360-740-8992
Practice Address - Fax:360-740-8993
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001112231H00000X
WALL00001021235Z00000X
WAHA00000691237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0030177OtherL&I WORKMANS COMP
WA7100746Medicaid
WA7035900Medicaid
WALL00001021Medicaid
HEARINGAIDS9035742OtherDSHS
0030177OtherL&I WORKMANS COMP