Provider Demographics
NPI:1205261757
Name:GONCHARENKO, ANNE CAMPBELL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:CAMPBELL
Last Name:GONCHARENKO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 WHITE BLUFF RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4668
Mailing Address - Country:US
Mailing Address - Phone:912-335-8486
Mailing Address - Fax:912-335-3528
Practice Address - Street 1:9100 WHITE BLUFF RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4668
Practice Address - Country:US
Practice Address - Phone:912-335-8486
Practice Address - Fax:912-335-3528
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008305235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist