Provider Demographics
NPI:1851164636
Name:BOMMAREDDY, ANNAPURRNAAH (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANNAPURRNAAH
Middle Name:
Last Name:BOMMAREDDY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7147 32ND AVE NE APT 203
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-3206
Mailing Address - Country:US
Mailing Address - Phone:209-587-9919
Mailing Address - Fax:
Practice Address - Street 1:10501 47TH AVE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3712
Practice Address - Country:US
Practice Address - Phone:253-583-5320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61444812235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist