Provider Demographics
NPI:1477897015
Name:HURTADO, ANNA E (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:E
Last Name:HURTADO
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 1:15037 LAKE BESSIE LOOP
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-9281
Mailing Address - Country:US
Mailing Address - Phone:601-606-7059
Mailing Address - Fax:
Practice Address - Street 1:1002 S DILLARD ST STE 106
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3991
Practice Address - Country:US
Practice Address - Phone:407-877-0029
Practice Address - Fax:407-358-5207
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3449235Z00000X
FLSA18456235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSS3449OtherMISSISSIPPI STATE BOARD OF HEALTH
MS12147580OtherASHA