Provider Demographics
NPI:1619127149
Name:SMALLEN, ANNE LOUISE
Entity Type:Individual
Prefix:
First Name:ANNE LOUISE
Middle Name:
Last Name:SMALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNE LOUISE
Other - Middle Name:
Other - Last Name:SMALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LIC AC
Mailing Address - Street 1:12422 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2958
Mailing Address - Country:US
Mailing Address - Phone:240-994-1789
Mailing Address - Fax:
Practice Address - Street 1:8555 16TH ST STE 402
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2802
Practice Address - Country:US
Practice Address - Phone:240-994-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-20
Last Update Date:2008-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01678171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist