Provider Demographics
NPI:1831329846
Name:MACNEIL, ANNE WOLFE (SLP-CCC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:WOLFE
Last Name:MACNEIL
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7412 S FITZGERALD ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33616-2131
Mailing Address - Country:US
Mailing Address - Phone:850-221-2010
Mailing Address - Fax:
Practice Address - Street 1:7412 S FITZGERALD ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33616-2131
Practice Address - Country:US
Practice Address - Phone:850-221-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16863235Z00000X
FLSZ4599235Z00000X
CA18460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist