Provider Demographics
NPI:1356755946
Name:PINKENBURG, ANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:PINKENBURG
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 1:5624 FURSMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76114-4512
Mailing Address - Country:US
Mailing Address - Phone:817-205-3842
Mailing Address - Fax:
Practice Address - Street 1:6850 MANHATTAN BLVD STE 204
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-1210
Practice Address - Country:US
Practice Address - Phone:817-207-1500
Practice Address - Fax:817-507-0702
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist