Provider Demographics
NPI:1437776309
Name:LILLEY, ANNA (MS, CCC-SLP, IBCLC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:LILLEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9934 MEADOWMEAD CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-3367
Mailing Address - Country:US
Mailing Address - Phone:704-654-8599
Mailing Address - Fax:980-938-6088
Practice Address - Street 1:9934 MEADOWMEAD CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3367
Practice Address - Country:US
Practice Address - Phone:704-654-8599
Practice Address - Fax:980-938-6088
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2104011235Z00000X
NCL-304060174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN