Provider Demographics
NPI:1275004004
Name:IWEMA, ANNA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:IWEMA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:HEFFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:1628 VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-4000
Mailing Address - Country:US
Mailing Address - Phone:214-724-6724
Mailing Address - Fax:
Practice Address - Street 1:12880 HILLCREST RD STE 102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1501
Practice Address - Country:US
Practice Address - Phone:972-287-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112554235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist