Provider Demographics
NPI:1568866267
Name:SIMON, ANNA MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:SIMON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 BANKS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-6021
Mailing Address - Country:US
Mailing Address - Phone:713-385-7847
Mailing Address - Fax:
Practice Address - Street 1:6109 MAPLE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-7449
Practice Address - Country:US
Practice Address - Phone:713-668-6690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17216235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist