Provider Demographics
NPI:1265064752
Name:POTUZAK, ANNA MARIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:POTUZAK
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 1:2515 COPPER BLVD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-1267
Mailing Address - Country:US
Mailing Address - Phone:406-640-2842
Mailing Address - Fax:
Practice Address - Street 1:2515 COPPER BLVD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-1267
Practice Address - Country:US
Practice Address - Phone:406-640-2842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-SP-LIC-8845235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist