Provider Demographics
NPI:1760842306
Name:HAZARD, ANNE BARRETT (MS, CCCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:BARRETT
Last Name:HAZARD
Suffix:
Gender:F
Credentials:MS, CCCC-SLP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:BARRETT
Other - Last Name:POLK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4127
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-4127
Mailing Address - Country:US
Mailing Address - Phone:662-207-0181
Mailing Address - Fax:
Practice Address - Street 1:1822 JOSEPHINE LOOP
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:622-207-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-3218235Z00000X
WYSP-642235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist