Provider Demographics
NPI:1508373234
Name:EUBANKS, ANNA MAE (SLP)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MAE
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 MARSHALL WAY
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6533
Mailing Address - Country:US
Mailing Address - Phone:530-344-5430
Mailing Address - Fax:530-344-5431
Practice Address - Street 1:1000 FOWLER WAY STE 6
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5738
Practice Address - Country:US
Practice Address - Phone:530-344-5430
Practice Address - Fax:530-344-5431
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18535235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist