Provider Demographics
NPI:1790129781
Name:CICHANOWSKI, ANN ITNYRE (SLP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:ITNYRE
Last Name:CICHANOWSKI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:L
Other - Last Name:ITNYRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1009 N GEORGETOWN ST
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3289
Mailing Address - Country:US
Mailing Address - Phone:512-255-1720
Mailing Address - Fax:
Practice Address - Street 1:1009 N GEORGETOWN ST
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3289
Practice Address - Country:US
Practice Address - Phone:512-255-1720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107413235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist