Provider Demographics
NPI:1548428196
Name:WOODCOCK, ANNA DOUGHERTY (MA/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:DOUGHERTY
Last Name:WOODCOCK
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:DOUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:660 COUNTY ROAD 405
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-8910
Mailing Address - Country:US
Mailing Address - Phone:423-506-1224
Mailing Address - Fax:
Practice Address - Street 1:660 COUNTY ROAD 405
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-8910
Practice Address - Country:US
Practice Address - Phone:423-506-1224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3671235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist