Provider Demographics
NPI:1629375852
Name:REEBENACKER, ANNMARIE HENSON (MED)
Entity Type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:HENSON
Last Name:REEBENACKER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:ANNMARIE
Other - Middle Name:
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18433 ROSCOE BLVD
Mailing Address - Street 2:#204
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4108
Mailing Address - Country:US
Mailing Address - Phone:818-727-7020
Mailing Address - Fax:818-727-7075
Practice Address - Street 1:3 ALLDS ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-4711
Practice Address - Country:US
Practice Address - Phone:603-880-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1756237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter