Provider Demographics
NPI:1851557359
Name:HODGE, ANITA J (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:J
Last Name:HODGE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 MILLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4316
Mailing Address - Country:US
Mailing Address - Phone:716-480-7102
Mailing Address - Fax:
Practice Address - Street 1:58 MILLBROOK DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4316
Practice Address - Country:US
Practice Address - Phone:716-480-7102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007597-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist