Provider Demographics
NPI:1235679200
Name:DAUS, ANNIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:
Last Name:DAUS
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 1:3835 SYLVAN CT SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-3597
Mailing Address - Country:US
Mailing Address - Phone:616-460-8758
Mailing Address - Fax:
Practice Address - Street 1:3835 SYLVAN CT SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-3597
Practice Address - Country:US
Practice Address - Phone:616-460-8758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101002455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist