Provider Demographics
NPI:1700177581
Name:MAHOLM, ANNE B
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:B
Last Name:MAHOLM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 STARLING CT APT 310
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-7925
Mailing Address - Country:US
Mailing Address - Phone:330-472-6597
Mailing Address - Fax:330-666-5626
Practice Address - Street 1:3560 W MARKET ST STE 400
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-2665
Practice Address - Country:US
Practice Address - Phone:330-668-4041
Practice Address - Fax:330-666-5626
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12144215235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist