Provider Demographics
NPI:1649649948
Name:DOMBO, ANNA MICHELE MAPLES (CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MICHELE MAPLES
Last Name:DOMBO
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:MICHELE
Other - Last Name:MAPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 PARK HILL DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3375
Mailing Address - Country:US
Mailing Address - Phone:504-446-2654
Mailing Address - Fax:540-479-1407
Practice Address - Street 1:321 PARK HILL DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3375
Practice Address - Country:US
Practice Address - Phone:504-446-2654
Practice Address - Fax:540-479-1407
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist