Provider Demographics
NPI:1245470459
Name:LADISCH, ANNA MATSUDA (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MATSUDA
Last Name:LADISCH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:MATSUDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3295 MENDEL DR
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-5177
Mailing Address - Country:US
Mailing Address - Phone:561-252-9909
Mailing Address - Fax:480-287-8021
Practice Address - Street 1:3295 MENDEL DR
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-5177
Practice Address - Country:US
Practice Address - Phone:561-252-9909
Practice Address - Fax:480-287-8021
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004643A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22004643AOtherINDIANA STATE BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY
MD12907686OtherASHA CERTIFICATION