Provider Demographics
NPI:1346986387
Name:PANCRATZ, ANNA MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:PANCRATZ
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 1:170 DEVON DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-5617
Mailing Address - Country:US
Mailing Address - Phone:563-495-2736
Mailing Address - Fax:
Practice Address - Street 1:170 DEVON DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-5617
Practice Address - Country:US
Practice Address - Phone:563-495-2736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA106603235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist