Provider Demographics
NPI:1851531511
Name:HOMMES, ANNE TH (MA, CCC/SP)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:TH
Last Name:HOMMES
Suffix:
Gender:F
Credentials:MA, CCC/SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1492
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-1492
Mailing Address - Country:US
Mailing Address - Phone:541-929-4568
Mailing Address - Fax:541-929-4513
Practice Address - Street 1:138 S. 12TH STREET
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-1492
Practice Address - Country:US
Practice Address - Phone:541-929-4568
Practice Address - Fax:541-929-4513
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11472235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist