Provider Demographics
NPI:1932235132
Name:POISSON, ANN L (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:L
Last Name:POISSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2056 GRANTS VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-4016
Mailing Address - Country:US
Mailing Address - Phone:636-464-9866
Mailing Address - Fax:
Practice Address - Street 1:2056 GRANTS VALLEY LN
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-4016
Practice Address - Country:US
Practice Address - Phone:636-464-9866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104755235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist