Provider Demographics
NPI:1558602847
Name:MIER-ANAYA, JUANA M (MS)
Entity Type:Individual
Prefix:MRS
First Name:JUANA
Middle Name:M
Last Name:MIER-ANAYA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JUANA
Other - Middle Name:M
Other - Last Name:MIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 690512
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95269-0512
Mailing Address - Country:US
Mailing Address - Phone:209-298-1758
Mailing Address - Fax:
Practice Address - Street 1:333 E CHANNEL ST STE 3
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2416
Practice Address - Country:US
Practice Address - Phone:209-298-1758
Practice Address - Fax:209-464-2723
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist