Provider Demographics
NPI:1588634828
Name:ADDIS, ANN BUCKLER (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:BUCKLER
Last Name:ADDIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2822
Mailing Address - Country:US
Mailing Address - Phone:610-668-2778
Mailing Address - Fax:
Practice Address - Street 1:330 BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2822
Practice Address - Country:US
Practice Address - Phone:610-668-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000939L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL000939LOtherSPEECH PATHOLOGIST