Provider Demographics
NPI:1356038350
Name:ENSOR, ANNA SUMMERLYN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:SUMMERLYN
Last Name:ENSOR
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14963 SUNNY WAY
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-3344
Mailing Address - Country:US
Mailing Address - Phone:205-799-5340
Mailing Address - Fax:
Practice Address - Street 1:564 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-2132
Practice Address - Country:US
Practice Address - Phone:334-491-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14288759261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech