Provider Demographics
NPI:1437579745
Name:KORTSEN, ANNA KORTSEN
Entity Type:Individual
Prefix:MS
First Name:ANNA KORTSEN
Middle Name:
Last Name:KORTSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-3469
Mailing Address - Country:US
Mailing Address - Phone:480-734-0576
Mailing Address - Fax:
Practice Address - Street 1:700 E SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-3469
Practice Address - Country:US
Practice Address - Phone:480-734-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA87482355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant