Provider Demographics
NPI:1679042097
Name:WINDHAM, ANNE ELYSE (RBT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:ELYSE
Last Name:WINDHAM
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 N DONNELLY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-5526
Mailing Address - Country:US
Mailing Address - Phone:352-720-5194
Mailing Address - Fax:407-386-7133
Practice Address - Street 1:441 N DONNELLY ST
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-5526
Practice Address - Country:US
Practice Address - Phone:352-720-5194
Practice Address - Fax:407-386-7133
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician