Provider Demographics
NPI:1790348381
Name:NOWACZYK, ANNA K (SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:K
Last Name:NOWACZYK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WOODBROOK LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1035
Mailing Address - Country:US
Mailing Address - Phone:585-734-7893
Mailing Address - Fax:214-305-3399
Practice Address - Street 1:10450 LOTTSFORD RD
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-2734
Practice Address - Country:US
Practice Address - Phone:301-541-5017
Practice Address - Fax:214-305-3399
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07852235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD07852Medicaid