Provider Demographics
NPI:1831584176
Name:MANN, ANNABELLE SHRADER (MCD-SLP)
Entity type:Individual
Prefix:
First Name:ANNABELLE
Middle Name:SHRADER
Last Name:MANN
Suffix:
Gender:F
Credentials:MCD-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 SELWYN AVE
Mailing Address - Street 2:APT D
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1654
Mailing Address - Country:US
Mailing Address - Phone:678-876-1922
Mailing Address - Fax:
Practice Address - Street 1:125 BALDWIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3364
Practice Address - Country:US
Practice Address - Phone:704-316-1916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1503311235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist