Provider Demographics
NPI:1811318850
Name:TEMPLE, ANN KATHERINE (MS)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:KATHERINE
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:TEMPLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:475 22ND AVENUE
Mailing Address - Street 2:BUILDING 302, ROOM 101
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816
Mailing Address - Country:US
Mailing Address - Phone:808-305-9750
Mailing Address - Fax:808-733-9154
Practice Address - Street 1:475 22ND AVENUE
Practice Address - Street 2:BUILDING 302, ROOM 101
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816
Practice Address - Country:US
Practice Address - Phone:808-305-9750
Practice Address - Fax:808-733-9154
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11635235Z00000X
HI1178235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1178OtherDEPARTMENT OF COMMERCE & CONSUMER AFFAIRS - STATE OF HAWAII
OH11635OtherOHIO BOARD OF SPEECH PATHOLOGY AND AUDIOLOGY