Provider Demographics
NPI:1376045799
Name:WILLOUGHBY, ANN E (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HARRIS HART RD
Mailing Address - Street 2:
Mailing Address - City:FLOYD
Mailing Address - State:VA
Mailing Address - Zip Code:24091-2184
Mailing Address - Country:US
Mailing Address - Phone:540-745-9440
Mailing Address - Fax:540-745-9494
Practice Address - Street 1:140 HARRIS HART RD
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-2184
Practice Address - Country:US
Practice Address - Phone:540-745-9440
Practice Address - Fax:540-745-9494
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist