Provider Demographics
NPI:1245585314
Name:OVERSTREET, ANNE KATHRYN (CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:KATHRYN
Last Name:OVERSTREET
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19434 E. LASALLE PLACE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-7701
Mailing Address - Country:US
Mailing Address - Phone:720-810-5988
Mailing Address - Fax:
Practice Address - Street 1:4950 LARKSPUR ST
Practice Address - Street 2:
Practice Address - City:BOW MAR
Practice Address - State:CO
Practice Address - Zip Code:80123-1547
Practice Address - Country:US
Practice Address - Phone:720-987-5477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0506001235Z00000X
CO12105054235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist