Provider Demographics
NPI:1205966686
Name:HOMUTH, ANNA K (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:K
Last Name:HOMUTH
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 1:3192 COUNTY ROAD 80
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3193
Mailing Address - Country:US
Mailing Address - Phone:507-451-4851
Mailing Address - Fax:
Practice Address - Street 1:903 S OAK AVE
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3200
Practice Address - Country:US
Practice Address - Phone:507-455-7631
Practice Address - Fax:507-444-6063
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist