Provider Demographics
NPI:1508585563
Name:BOHANNON, ANNE HOLLOWAY (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:HOLLOWAY
Last Name:BOHANNON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:HOLLOWAY
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:4913 OAKS CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-4921
Mailing Address - Country:US
Mailing Address - Phone:859-816-1190
Mailing Address - Fax:
Practice Address - Street 1:4913 OAKS CT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-4921
Practice Address - Country:US
Practice Address - Phone:859-816-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11597235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11597OtherOHIO SPEECH AND HEARING PROFESSIONALS BOARD
14051394OtherASHA
OHOH3228036OtherOHIO DEPARTMENT OF EDUCATION PUPIL SERVICES LICENSE