Provider Demographics
NPI:1740320423
Name:CHENOWETH, ANNA (MS, CCCSLP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:CHENOWETH
Suffix:
Gender:F
Credentials:MS, CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 3RD ST
Mailing Address - Street 2:SUITE 26
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3831
Mailing Address - Country:US
Mailing Address - Phone:304-614-6390
Mailing Address - Fax:
Practice Address - Street 1:108 3RD ST
Practice Address - Street 2:SUITE 26
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3831
Practice Address - Country:US
Practice Address - Phone:304-614-6390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001021Medicaid