Provider Demographics
NPI:1740432319
Name:FENNELL, ANN MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:FENNELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HAWKINS DRIVE
Mailing Address - Street 2:THE UNIVERSITY OF IOWA
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1012
Mailing Address - Country:US
Mailing Address - Phone:319-335-8736
Mailing Address - Fax:319-335-8851
Practice Address - Street 1:250 HAWKINS DRIVE
Practice Address - Street 2:THE UNIVERSITY OF IOWA
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1012
Practice Address - Country:US
Practice Address - Phone:319-335-8736
Practice Address - Fax:319-335-8851
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00904235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist