Provider Demographics
NPI:1205089158
Name:SEABOLDT, ANNE L
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:L
Last Name:SEABOLDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PONDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-2652
Mailing Address - Country:US
Mailing Address - Phone:203-746-8084
Mailing Address - Fax:203-746-8084
Practice Address - Street 1:15 PONDFIELD RD
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812-2652
Practice Address - Country:US
Practice Address - Phone:203-746-8084
Practice Address - Fax:203-746-8084
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004670-1235Z00000X
CT003940235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist