Provider Demographics
NPI:1760974091
Name:KOELZER, ANNA MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNA MARIE
Middle Name:
Last Name:KOELZER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:ANNA MARIE
Other - Middle Name:
Other - Last Name:SANDERFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:108 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3926
Mailing Address - Country:US
Mailing Address - Phone:832-930-3105
Mailing Address - Fax:
Practice Address - Street 1:180 MONTGOMERY ST STE 1850
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-4278
Practice Address - Country:US
Practice Address - Phone:832-930-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31960235Z00000X
ND1809235Z00000X
TX113421235Z00000X
14297933235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist