Provider Demographics
NPI:1568853026
Name:STA. MARIA-NASE, ANNA MARIE (SLP)
Entity Type:Individual
Prefix:MS
First Name:ANNA MARIE
Middle Name:
Last Name:STA. MARIA-NASE
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 1:790 OAK TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-7502
Mailing Address - Country:US
Mailing Address - Phone:770-212-2170
Mailing Address - Fax:770-783-8639
Practice Address - Street 1:7440 HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-3527
Practice Address - Country:US
Practice Address - Phone:770-212-2170
Practice Address - Fax:770-783-8639
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist