Provider Demographics
NPI:1700121803
Name:WHITE, ANNA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:WHITE
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 1:2765 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8331
Mailing Address - Country:US
Mailing Address - Phone:540-720-2261
Mailing Address - Fax:540-720-5660
Practice Address - Street 1:10700 BALLANTRAYE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FREDERICKSBRG
Practice Address - State:VA
Practice Address - Zip Code:22407-4700
Practice Address - Country:US
Practice Address - Phone:540-720-2261
Practice Address - Fax:540-720-5660
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006883235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist