Provider Demographics
NPI:1295333433
Name:DOUTHAT, ANN LOCKARD (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:LOCKARD
Last Name:DOUTHAT
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 PARKCREST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-4211
Mailing Address - Country:US
Mailing Address - Phone:540-589-8423
Mailing Address - Fax:
Practice Address - Street 1:3613 GRAHAM PARK RD
Practice Address - Street 2:
Practice Address - City:TRIANGLE
Practice Address - State:VA
Practice Address - Zip Code:22172-1101
Practice Address - Country:US
Practice Address - Phone:703-221-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000603235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist