Provider Demographics
NPI:1275698151
Name:WALLWORK, ANNE HOLLAND (SLP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:HOLLAND
Last Name:WALLWORK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 LAKE BOONE TRAIL S
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7511
Mailing Address - Country:US
Mailing Address - Phone:919-781-4434
Mailing Address - Fax:919-781-5851
Practice Address - Street 1:4201 LAKE BOONE TRAIL
Practice Address - Street 2:SUITE 4
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7511
Practice Address - Country:US
Practice Address - Phone:919-781-4434
Practice Address - Fax:919-781-5851
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6844235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412338Medicaid
4600072OtherUNITED HEALTHCARE
7117612OtherAETNA
NC13926OtherBCBS
NC8300041KOtherMEDICAID CBRS