Provider Demographics
NPI:1780225938
Name:GERSHBERG, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GERSHBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 KINGFISHER LN
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-3529
Mailing Address - Country:US
Mailing Address - Phone:214-686-8565
Mailing Address - Fax:
Practice Address - Street 1:900 W LEUDA ST
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3002
Practice Address - Country:US
Practice Address - Phone:817-332-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist