Provider Demographics
NPI:1942674817
Name:HARBOUR, ANITA SUSAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:SUSAN
Last Name:HARBOUR
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:SUSAN
Other - Last Name:HOMCHICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:621 LINWOOD AVE SW
Mailing Address - Street 2:TUMWATER SCHOOL DISTRICT
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6847
Mailing Address - Country:US
Mailing Address - Phone:360-709-7040
Mailing Address - Fax:360-709-7042
Practice Address - Street 1:621 LINWOOD AVE SW
Practice Address - Street 2:TUMWATER SCHOOL DISTRICT
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-6847
Practice Address - Country:US
Practice Address - Phone:360-709-7040
Practice Address - Fax:360-709-7042
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60340785235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist