Provider Demographics
NPI:1184745598
Name:ANDERSON, NORA JEAN (SLP)
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:JEAN
Last Name:ANDERSON
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 1:1314 MOCKINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-7171
Mailing Address - Country:US
Mailing Address - Phone:515-432-3706
Mailing Address - Fax:
Practice Address - Street 1:1015 UNION ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-4821
Practice Address - Country:US
Practice Address - Phone:515-433-8625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01761T235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist