Provider Demographics
NPI:1558884106
Name:BARTKE, ANJA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANJA
Middle Name:
Last Name:BARTKE
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 1:1700 LIVE OAK LN
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-4568
Mailing Address - Country:US
Mailing Address - Phone:214-282-6161
Mailing Address - Fax:
Practice Address - Street 1:612 E BETHANY DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-4050
Practice Address - Country:US
Practice Address - Phone:972-727-0511
Practice Address - Fax:972-727-0500
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist