Provider Demographics
NPI:1417502410
Name:HARBOTTLE, ANNALINDA ELIZABETH
Entity Type:Individual
Prefix:
First Name:ANNALINDA
Middle Name:ELIZABETH
Last Name:HARBOTTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANI
Other - Middle Name:ELIZABETH
Other - Last Name:HARBOTTLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4130 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-3012
Mailing Address - Country:US
Mailing Address - Phone:949-413-4981
Mailing Address - Fax:
Practice Address - Street 1:2015 PIONEER CT STE P2
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1736
Practice Address - Country:US
Practice Address - Phone:949-413-4981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13712235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist