Provider Demographics
NPI:1679948137
Name:GIEDD, ANNA MARIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:ANNA MARIE
Middle Name:
Last Name:GIEDD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 112TH ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-6506
Mailing Address - Country:US
Mailing Address - Phone:715-271-6663
Mailing Address - Fax:
Practice Address - Street 1:475 CHIPPEWA MALL DR STE 310
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5034
Practice Address - Country:US
Practice Address - Phone:715-861-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13328-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13328-146OtherSTATE OF WISCONSIN